Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua.
Pathology Unit, Dell'Angelo General Hospital, Venice.
Anticancer Drugs. 2021 Feb 1;32(2):222-225. doi: 10.1097/CAD.0000000000000991.
In the past few years, the immune checkpoint inhibitor (ICI) nivolumab has become standard of care in the treatment of metastatic renal cell carcinoma (mRCC) progressing after antiangiogenic agents. To date, neither expression of programmed death ligand-1 (PD-L1) nor any other biomarker can be used to predict responses to ICIs, although intermediate-poor International Metastatic Database of Renal Carcinoma (IMDC) risk patients and those with sarcomatoid tumors appear to achieve superior benefit from immunotherapy. Paradoxically, ICIs may sometimes increase the speed of tumor growth. This rare phenomenon, called hyperprogression, has first been described in patients with melanoma and lung cancer treated with ICIs and is associated with poor survival. Here, we present the case of a patient affected by an intermediate IMDC risk mRCC with diffuse sarcomatoid features who achieved long disease control with first-line sunitinib and then started a second-line treatment with nivolumab. Unexpectedly, he experienced a dramatic acceleration of tumor growth and died soon after the third infusion of nivolumab. Then, we review the frequency of hyperprogression in mRCC and discuss the biological peculiarity of sarcomatoid RCC in terms of different responses to ICIs and antiangiogenic agents.
在过去的几年中，免疫检查点抑制剂（ICI）nivolumab 已成为抗血管生成药物治疗后进展的转移性肾细胞癌（mRCC）的标准治疗方法。迄今为止，程序性死亡配体 1（PD-L1）的表达或任何其他生物标志物都不能用于预测对 ICI 的反应，尽管中间差别的国际转移性肾细胞癌数据库（IMDC）风险患者和肉瘤样肿瘤患者似乎从免疫治疗中获得了更好的益处。矛盾的是，ICI 有时可能会增加肿瘤生长的速度。这种罕见现象称为超进展，最初在接受 ICI 治疗的黑色素瘤和肺癌患者中描述，并与不良生存相关。在这里，我们介绍了一位患有中间 IMDC 风险 mRCC 弥漫性肉瘤样特征的患者的病例，他在一线舒尼替尼治疗后实现了长期疾病控制，然后开始二线 nivolumab 治疗。出乎意料的是，他经历了肿瘤生长的急剧加速，并在接受nivolumab 第三次输注后不久死亡。然后，我们回顾了 mRCC 中超进展的频率，并讨论了肉瘤样 RCC 的生物学特殊性，包括对 ICI 和抗血管生成药物的不同反应。
