A Pathological Complete Response to the Combination of Ipilimumab and Nivolumab in a Patient with Metastatic Renal Cell Carcinoma

Študentová, Hana; Zemánková, Anežka; Spisarová, Martina; Skanderová, Daniela; Tüdös, Zbyněk; Melichar, Bohuslav; Študent, Vladimír

doi:10.3390/medicina58030336

Cited by 7 publications

(3 citation statements)

References 54 publications

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“…Once a response in the primary as well as the metastatic sites is obtained, CN that has so far been deferred can be offered. Not surprisingly, surgical complete remissions can be achieved including pathologic CRs [126][127][128]. Another important aspect is the discrepancy between the radiological outcome and the pathological findings in the resection specimen as described previously in the literature [129].…”

Section: Discussion and Future Perspectivesmentioning

confidence: 88%

The Evolving Landscape of Cytoreductive Nephrectomy in Metastatic Renal Cell Carcinoma

Studentova,

Spisarova,

Kopova

et al. 2023

Cancers

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The role of cytoreductive nephrectomy in metastatic renal cell carcinoma (RCC) has been studied intensively over the past few decades. Interestingly, the opinion with regard to the importance of this procedure has switched from a recommendation as a standard of care to an almost complete refutation. However, no definitive agreement on cytoreductive nephrectomy, including the pros and cons of the procedure, has been reached, and the topic remains highly controversial. With the advent of immune checkpoint inhibitors, we have experienced a paradigm shift, with immunotherapy playing a crucial role in the treatment algorithm. Nevertheless, obtaining results from prospective clinical trials on the role of cytoreductive nephrectomy requires time, and once some data have been gathered, the standards of systemic therapy may be different, and we stand again at the beginning. This review summarizes current knowledge on the topic in the light of newly evolving treatment strategies. The crucial point is to recognize who could be an appropriate candidate for immediate cytoreductive surgery that may facilitate the effect of systemic therapy through tumor debulking, or who might benefit from deferred cytoreduction in the setting of an objective response of the tumor. The role of prognostic factors in management decisions as well as the technical details associated with performing the procedure from a urological perspective are discussed. Ongoing clinical trials that may bring new evidence for transforming therapeutic paradigms are listed.

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Section: Discussion and Future Perspectivesmentioning

confidence: 88%

The Evolving Landscape of Cytoreductive Nephrectomy in Metastatic Renal Cell Carcinoma

Studentova,

Spisarova,

Kopova

et al. 2023

Cancers

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“…In the Checkmate-9ER trial 5.6% patients discontinued both agents and nearly 20% patients permanently stopped the combination therapy and continued with single agent therapy due to adverse events (3). Toxicity may develop later during the course of therapy such as the case of a RCC patient who developed hypophysitis 9 months after ICI therapy initiation that manifested during the postoperative course following cytoreductive nephrectomy (25). Adverse events induced by ICIs may be unpredictable and patients whenever received immunotherapy should be carefully followed for potential side effects.…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant nivolumab and cabozantinib in advanced renal cell carcinoma in a horseshoe kidney – how to achieve a safe and radical resection? a case report and review of the literature

Zemankova,

Studentova,

Kopova

et al. 2023

Front. Oncol.

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IntroductionNeoadjuvant nivolumab and cabozantinib in locally advanced renal cell carcinoma in a horseshoe kidney is a novel therapeutic approach in the preoperative setting.MethodsWe report a case of a 52-year old male who presented with a large inoperable tumor of the horseshoe kidney and achieved major partial radiologic response after neoadjuvant therapy with nivolumab and cabozantinib leading to radical resection of the tumor. The patient remains tumor free on the subsequent follow-up and his renal function is only mildly decreased. The systemic treatment was complicated by hepatotoxicity leading to early nivolumab withdrawal.ResultsCurrently, the combination therapy based on immune checkpoint inhibitors and tyrosine kinase inhibitors represents the treatment of choice in treatment-naïve patients with metastatic renal cell carcinoma in any prognostic group. The neoadjuvant treatment approach is being tested in prospective clinical trials and results are eagerly awaited. Renal cell carcinoma in a horseshoe kidney is an uncommon finding that is always challenging. Additionally, management guidance in this patient population is lacking. In some patients neoadjuvant therapy could be the only way to preserve kidney function. The initial treatment strategy should be individualized to patient needs aiming at the radical resection of the primary tumor as the only chance of getting the tumor under control in the long term.ConclusionHerein, we highlight the feasibility of neoadjuvant systemic therapy with nivolumab and cabozantinib allowing the subsequent performance of radical tumor resection with negative margins in a patient with advanced renal cell carcinoma in a horseshoe kidney, removing the primary tumor while sparing the patient from lifelong dialysis.

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“…diagnosis of objective and complete responses is usually based on imaging, and, without pathological examination of tissue from prospective clinical trials, the rate of pCR is unknown. To our knowledge, only few cases of pCR on specimens from resected RCC after ICI-based combinations are described in the literature [16][17][18][19][20][21][22][23][24][25][26] (Table 1). However, since surgical resection of residual disease is rarely performed, the true rate of pCR to ICI-based treatments may be underestimated.…”

Section: Case Reports In Oncologymentioning

confidence: 99%

Pathological Complete Response to Pembrolizumab plus Axitinib Combination following Serious Immune-Related Adverse Events in an Advanced Renal Cell Carcinoma Patient with a History of Rheumatoid Arthritis

Bergamini,

Dalla Volta,

Valcamonico

et al. 2024

Case Rep Oncol

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Immune checkpoint inhibitors (ICIs)-based combinations have improved survival outcomes of advanced renal cell carcinoma (RCC) patients and are currently recommended as first-line treatment options. Rheumatoid arthritis (RA) is a systemic autoimmune disease (AD) of unknown etiology characterized by a chronic inflammatory process involving joints and extra-articular organs. Patients with AD are usually excluded from large randomized clinical trials investigating immunotherapeutic drugs. Therefore, little is known about clinical outcomes of patients with a history of RA treated with ICIs in real-world practice. In the present study, we report the clinical outcome of an advanced RCC patient with a history of RA treated with pembrolizumab in combination with axitinib. The patient experienced serious immune-related adverse events (irAEs) and achieved pathological complete response following only one ICI administration. Our case report shows that ICI-based combinations can be administered efficaciously in advanced RCC patients with a history of AD. However, a close monitoring of these patients is required, given the risk of irAEs and clinical exacerbations of symptoms associated with the preexisting AD. Moreover, prospective clinical data are needed to assess the hypothesis of a correlation between the onset of irAEs and AD flares and responses and survival outcomes to ICIs.

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A Pathological Complete Response to the Combination of Ipilimumab and Nivolumab in a Patient with Metastatic Renal Cell Carcinoma

Cited by 7 publications

References 54 publications

The Evolving Landscape of Cytoreductive Nephrectomy in Metastatic Renal Cell Carcinoma

The Evolving Landscape of Cytoreductive Nephrectomy in Metastatic Renal Cell Carcinoma

Neoadjuvant nivolumab and cabozantinib in advanced renal cell carcinoma in a horseshoe kidney – how to achieve a safe and radical resection? a case report and review of the literature

Pathological Complete Response to Pembrolizumab plus Axitinib Combination following Serious Immune-Related Adverse Events in an Advanced Renal Cell Carcinoma Patient with a History of Rheumatoid Arthritis

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