Primary tumor resection after nivolumab treatment for metastatic renal cell carcinoma: A case report

Abstract

Abstract Background Several immune checkpoint blockades (ICBs) such as anti-CTLA-4 monoclonal antibody (mAb) and anti-PD-1 mAb are in clinical use. In renal cell carcinoma (RCC), it is indicated that anti-PD-1 mAb nivolumab is effective for patients who received antiangiogenic therapy regimens. However, efficacy of nivolumab as a neoadjuvant therapy has not been indicated. We report the case in which nivolumab was effective for the lung metastatic lesions of renal cell carcinoma and we could resect the primary tumor. Case presentation A 69-year-old woman was referred to our hospital and diagnosed as metastatic left RCC, cT3aN0M1 (multiple lung metastasis), cStageIV. After sequential treatment with TKIs and mTOR inhibitor, nivolumab was administered as the fifth treatment. Drug induced interstitial pneumonia occurred 6 days after the initial administration, so nivolumab was not administered thereafter. In course of 4 months, the lung metastatic lesions sharply reduced and we could resect the primary tumor. In addition, we analyzed tumor infiltrated lymphocytes (TILs) in this case with flow cytometry and compared with the other 20 tumors resected from September 2017 to May 2018 in Kyushu university hospital. The phenotype of TILs in stagIV RCC after nivolumab administration was close to those of low stage RCC. Conclusion Currently, nivolumab treatment as a neoadjuvant therapy for metastatic RCC is not common. We report a metastatic RCC case in which we resected primary tumor after administration of nivolumab and analyzed TILs with flow cytometry.