Abstract
BackgroundCurrently, immunotherapy is indicated for patients with metastatic RCC or unresectable RCC, but there is no indication for immunotherapy in the neoadjuvant setting. We report a case in which the combined use of nivolumab and ipilimumab and sequential TKI therapy enabled surgical treatment.Case presentationA 71-year-old female was diagnosed with a metastatic clear-cell renal cell carcinoma with a level IV tumor thrombus. She was started on nivolumab-ipilimumab therapy, and was switched to pazopanib monotherapy because the tumor thrombus progressed within the right atrium. The tumor shrank to resectable status with sequential therapy. She then underwent right nephrectomy and thrombectomy. Pathological analysis showed 10–20% residual tumor in the primary tumor, but no viable cells in tumor thrombus. She remains clinically disease-free 1 year after surgery.ConclusionThis case suggests the utility of sequential immune-targeted therapy as neoadjuvant therapy in advanced renal cell carcinoma.
Highlights
Immunotherapy is indicated for patients with metastatic Renal cell carcinoma (RCC) or unresectable RCC, but there is no indication for immunotherapy in the neoadjuvant setting
Immunotherapy is indicated for patients with metastatic RCC or unresectable RCC, but there are Nishimura et al BMC Urol (2021) 21:124 no indications for immunotherapy in the neoadjuvant setting
Systemic immunotherapy was administered for metastatic RCC based on International Metastatic RCC Database Consortium (IMDC) poor-risk classification including Karnofsky performance status (KPS) < 80%, diagnosis to treatment interval < 1 year, anemia, and hyper calcemia
Summary
Immunotherapy is indicated for patients with metastatic RCC or unresectable RCC, but there is no indication for immunotherapy in the neoadjuvant setting. Conclusion: This case suggests the utility of sequential immune-targeted therapy as neoadjuvant therapy in advanced renal cell carcinoma. The 5-year survival rate after nephrectomy and tumor thrombectomy among RCC patients with tumor thrombus in the inferior vena cava (IVC) is approximately 50% [1].
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