A 60-year-old male, chronic smoker presented with gross hematuria, pain in the left flank along with significant history of weight loss, fever and shoness of breath for 3 months. O/E, a mass was palpated in the left flank which was firm in consistency and about 5x5 cm in dimensions along with a left sided varicocele was noted. Lab findings revealed anemia along with hypercalcemia. Kidney biopsy was also done. Chest X-ray CECT pelvis All of the following are approved for the above condition except: -

Nilotinib is a tyrosine kinase inhibitor given in CML. This is a case of metastatic renal cell carcinoma with cannon ball metastasis in lungs. Chest x-ray shows multiple, bilateral, rounded soft tissue density massessuggestive of cannon ball metastasis in renal cell carcinoma. CT image shows the classical renal cell carcinoma. HPE image is classical of clear cell renal carcinoma. DRUGS APPROVED FOR RENAL CELL CARCINOMA: - Cytokines: - High dose interleukin-2, Interferon-alpha Tyrosine kinase inhibitors: - Sorafenib, Sunitinib, Pazopanib, Axitinib, Carbozantinib, Lenvatinib VEGF ligand antibody: - Bevacizumab mTOR inhibitors: - Temsirolimus, Everolimus PD-1 inhibitor: - Nivolumab