by Paul R. Helft, MD1 | March 1, 2013
quote:I was asked to see a patient with widely metastatic renal cell carcinoma in the ICU. He is a 47-year-old man who had a large, clear-cell primary renal cell carcinoma resected 21 months ago; had a recurrence in retroperitoneal lymph nodes, bones, and lungs; and was treated with three lines of therapy but had no response and continued to progress. In the 6 weeks prior to the current hospital admission, he became progressively more debilitated, was eventually wheelchair-bound, and became increasingly short of breath. When he was admitted, he was in florid respiratory failure from compression of his inferior vena cava and right atrium and compression of his left lower lobe bronchus. He was immediately intubated and sedated; he eventually became paralyzed because of progressive worsening of his respiratory status. I saw him as a consult and visited nearly every day for 5 days. His wife, who is his primary spokesperson, has continued to demand that I provide him with sorafenib(Drug information on sorafenib) (Nexavar), since she read that it works in kidney cancer and it is one of the treatments he has not tried. She says that he was always “a fighter,” competing in triathlons even after his diagnosis. Should I provide the patient with sorafenib, just to satisfy his wife, since it is unlikely to do much harm?
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