Abstract
Combined immune checkpoint blockade with nivolumab and ipilimumab is standard therapy for the treatment of patients with previously untreated advanced renal cell carcinoma who are at intermediate or poor risk. However, data about the safety and efficacy of combined immune checkpoint blockade with nivolumab and ipilimumab in patients on hemodialysis are limited. Renal function has no known clinically important effects on the pharmacokinetics and clearance of nivolumab and ipilimumab. Further, most immune-related adverse events in patients on hemodialysis are thought to be manageable with the same treatments applied in patients with normal renal function. We present a case of advanced clear-cell renal cell carcinoma in a patient on hemodialysis who received combined immune checkpoint blockade with nivolumab and ipilimumab and who showed no evident signs of immune-related adverse events. Here, we confirm the safety and efficacy of combined immune checkpoint blockade with nivolumab and ipilimumab in a patient on hemodialysis.
Highlights
Immune checkpoint blockade offers significant benefit in the treatment of cancer[1]
We present a case of advanced clear-cell renal cell carcinoma in a patient on hemodialysis who received combined immune checkpoint blockade with nivolumab and ipilimumab and who showed no evident signs of immune-related adverse events
Several case studies have suggested that patients on hemodialysis can be treated safely and efficaciously with nivolumab or ipilimumab monotherapy[7,8], no reports have been published describing the safety and efficacy of combined therapy in patients on hemodialysis
Summary
Immune checkpoint blockade offers significant benefit in the treatment of cancer[1]. It enhances the antitumour immune response by reducing endogenous immune downregulators such as PD-1 and ctla-42. Nivolumab is a PD-1 immune checkpoint inhibitor antibody whose monotherapy shows favourable antitumour efficacy in several types of tumours, including advanced renal cell carcinoma (rcc)[3]. The patient continued to receive hemodialysis 3 times weekly, with a stable serum creatinine level and no electrolyte abnormalities He had no clinical symptoms, and blood chemistry tests showed normal C-reactive protein, liver function, and no significant changes in coagulation and endocrine function. He had no evident signs of immune-related adverse events (iraes), with stable disease at 8 months after initiation of the combined immune checkpoint blockade with ipilimumab and nivolumab
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