Tucker Matthew D, Beckermann Kathryn E, Gordetsky Jennifer B, Giannico Giovanna A, Davis Nancy B, Rini Brian I
Department of Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN, United States.
Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, United States.
Front Oncol. 2020 Dec 22;10:609235. doi: 10.3389/fonc.2020.609235. eCollection 2020.
Immunotherapy-based combinations have become standard of care in advanced renal cell carcinoma (RCC). Despite the potential for complete radiographic response, complete pathologic responses have been rarely reported. We present two cases of confirmed complete pathologic response to immunotherapy despite residual radiographic abnormalities. The first case describes a 68-year-old female with metastatic RCC who was treated with upfront pembrolizumab plus axitinib. She underwent nephrectomy after 15 doses of pembrolizumab with pathology revealing no evidence of viable tumor. To our knowledge, this is the first reported case of a complete pathologic response with pembrolizumab in metastatic RCC. The second case describes a 64-year-old female with metastatic RCC who was treated with second-line nivolumab after progression on cabozantinib. After 13 doses of nivolumab, she underwent nephrectomy with pathology revealing no evidence of viable tumor. These cases highlight the potential for scar tissue, fibrosis, and necrosis to persist radiographically after treatment with immunotherapy despite the absence of viable tumor cells.
基于免疫疗法的联合治疗已成为晚期肾细胞癌（RCC）的标准治疗方案。尽管有可能出现完全的影像学缓解，但完全病理缓解的情况却鲜有报道。我们报告了两例尽管存在残留影像学异常但经免疫治疗后确诊为完全病理缓解的病例。第一例是一名68岁的转移性RCC女性患者，接受了一线帕博利珠单抗联合阿昔替尼治疗。在接受15剂帕博利珠单抗治疗后，她接受了肾切除术，病理检查显示无存活肿瘤证据。据我们所知，这是转移性RCC中首例报告的帕博利珠单抗治疗后完全病理缓解的病例。第二例是一名64岁的转移性RCC女性患者，在卡博替尼治疗进展后接受二线纳武利尤单抗治疗。在接受13剂纳武利尤单抗治疗后，她接受了肾切除术，病理检查显示无存活肿瘤证据。这些病例突出了免疫治疗后，尽管不存在存活肿瘤细胞，但瘢痕组织、纤维化和坏死仍可能在影像学上持续存在的可能性。
