title: Metachronous pancreatic metastases from renal cell carcinoma: is there a place of Active-Surveillance before deferred deliberately Molecular Target Agent?
abstract: BACKGROUND
  Metastatic renal cell cancer is a heterogeneous disease due to its diverse morphological features, the prognostic categories based on clinical criteria. Sometimes indolent course without any significant symptoms can be differentiated before the introduction of novel targeted agents. This observation led to interest in a strategy of deferring systemic therapy in the era of effective systemic therapies.
  
  
  METHODS
  We report of a 78-year-old Moroccan man with pancreatic metastasis from renal cell carcinoma which occurred 14 years from right nephrectomy. Indolent disease based on body computed tomography imaging with 4 years follow-up was recognized. Active surveillance with deferred antiangiogenic multikinase inhibitor at disease progression was proposed. Nowadays, the patient is under oncological follow-up, he is in a good state of health, and he is disease-free for 48 months from the diagnosis of the tumor and for 20 months from the start of the treatment with Sunitinib
  
  
  CONCLUSIONS
  Active surveillance before target therapy may be a suitable approach to ensure long progression-free survival with minimal side-effects and better quality of life in asymptomatic, low-volume, metastatic disease. Further prospective studies with biomarker validation are required to define the patients most likely to benefit from this approach.
authors.affiliation: Department of Medical Oncology, University Military Hospital, Rabat, 10000, Morocco. sbittiyassir@yahoo.fr.|Department Medical Oncology, Teaching University Military Hospital and Faculty of Medicine and Pharmacy of Fes, Hay Ryad, Rabat, 10000, Morocco. sbittiyassir@yahoo.fr.
authors.forename: Yassir
authors.initials: Y
authors.lastname: Sbitti
authors.affiliation: Department of Gastroenterology, University Military Hospital, Rabat, 10000, Morocco.
authors.forename: Hassan
authors.initials: H
authors.lastname: Seddik
authors.affiliation: Department of Medical Oncology, University Military Hospital, Rabat, 10000, Morocco.
authors.forename: Adil
authors.initials: A
authors.lastname: Debbagh
authors.affiliation: Department of Medical Oncology, University Military Hospital, Rabat, 10000, Morocco.
authors.forename: Fahd
authors.initials: F
authors.lastname: Benani
authors.affiliation: Department of Medical Oncology, University Military Hospital, Rabat, 10000, Morocco.
authors.forename: Khaoula
authors.initials: K
authors.lastname: Slimani
authors.affiliation: Department of Pathology, University Military Hospital of Instruction, Rabat, 10000, Morocco.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mahi
authors.affiliation: Department of Surgery, University Military Hospital of Instruction, Rabat, 10000, Morocco.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Tarchouli
authors.affiliation: Department of Pathology, University Military Hospital of Instruction, Rabat, 10000, Morocco.
authors.forename: Abdelmounaim
authors.initials: A
authors.lastname: Aitali
authors.affiliation: Department of Radiology, University Military Hospital of Instruction, Rabat, 10000, Morocco.
authors.forename: Abderrahmane
authors.initials: A
authors.lastname: Albouzidi
authors.affiliation: Department of Medical Oncology, National Institute of Oncology, Rabat, 10000, Morocco.
authors.forename: Hassan
authors.initials: H
authors.lastname: Errihani
authors.affiliation: Department of Medical Oncology, University Military Hospital, Rabat, 10000, Morocco.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Ichou
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology*; D008297:Male; D058990:Molecular Targeted Therapy; D016609:Neoplasms, Second Primary / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000378:metabolism / Q000556:secondary*; D011379:Prognosis; D011758:Pyrroles / Q000627:therapeutic use; D000077210:Sunitinib
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D011758:Pyrroles; D000077210:Sunitinib
keywords: Active surveillance; Molecular target therapy; Pancreatic metastases; Renal cell carcinoma