Sequential immune-targeted surgical therapy resulted in disease-free survival in a case with advanced renal cell carcinoma

Abstract

Background Currently, 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 presentation A 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. Conclusion This case suggests the utility of sequential immune-targeted therapy as neoadjuvant therapy in advanced renal cell carcinoma.

Neoadjuvant Nivolumab and Ipilimumab for Nonmetastatic Renal Cell Carcinoma with Tumor Thrombus

“…In several reports, neoadjuvant nivolumab and ipilimumab combination therapy resulted in various degrees of tumor thrombus regression in patients with metastatic RCC with tumor thrombus. [ 4 , 5 , 7 – 9 ] The use of nivolumab and ipilimumab in nonmetastatic RCC with tumor thrombus, as in this case, has been scarcely reported. In a report by Labbate et al,[ 6 ] four cycles of combination therapy followed by four cycles of nivolumab monotherapy successfully downstaged a level IV tumor thrombus to level III in locally advanced RCC.…”

The Role of Anticoagulation in Tumor Thrombus Associated with Renal Cell Carcinoma: A Literature Review

“…A 71-year-old female, also with grade IV TT and RCC, received combined immunotherapy with nivolumab and ipilimumab. She experienced TT progression into the right atrium while undergoing treatment [33]. Treatment was then switched to pazopanib monotherapy for five months.…”

“…Treatment was then switched to pazopanib monotherapy for five months. Following treatment with pazopanib, her renal mass decreased and the patient was able to undergo right nephrectomy [33]. Presurgical pazopanib for RCC with TT was further addressed in a retrospective review of seven patients.…”