Cheeloo College of Medicine, Shandong University, Jinan, China.
Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
Front Immunol. 2021 Jun 15;12:646085. doi: 10.3389/fimmu.2021.646085. eCollection 2021.
There is little evidence around Camrelizumab combined with cytoreductive nephrectomy (CN) and radiotherapy (RT) as a treatment option for metastatic renal cell carcinoma (mRCC). The influence of CN on immune responses and the abscopal effect are not well understood. In this paper, we report a case of anti-programmed cell death-1 (PD-1) treated with combined RT once CN reduced the primary tumor burden (TB). This patient also encountered an increased response to targeted radiotherapy after immune resistance. We also observed a macrophage-to-lymphocyte ratio (MLR) peak, which may be correlated with subsequent pseudoprogression after thoracic radiotherapy. Consequently, even with the disease, this patient has remained stable. This peculiar instance suggests there is a need to investigate the underlying mechanisms of CN in promoting the abscopal effect during immunotherapy when combined with RT. It also suggests that there is a need for further investigation into the role of RT in overcoming immune resistance, and the value of MLR in predicting pseudoprogression. We hypothesize that a heavy tumor burden might suppress the abscopal effect, thereby ensuring that CN promotes it. However, radiotherapy may overcome immune resistance during oligoprogression.
卡瑞利珠单抗联合肾细胞减瘤术（CN）和放疗（RT）治疗转移性肾细胞癌（mRCC）的证据有限。CN 对免疫反应和远隔效应的影响尚不清楚。本文报告了一例抗程序性细胞死亡蛋白-1（PD-1）治疗病例，在 CN 降低原发肿瘤负担（TB）后联合 RT 治疗。该患者还在免疫耐药后对靶向放疗有了更高的反应。我们还观察到一个巨噬细胞与淋巴细胞比值（MLR）峰值，这可能与随后的胸部放疗后假性进展有关。因此，即使疾病存在，该患者仍保持稳定。这一特殊情况表明，需要研究 CN 在联合 RT 进行免疫治疗时促进远隔效应的潜在机制。这也表明需要进一步研究 RT 在克服免疫耐药性中的作用，以及 MLR 在预测假性进展中的价值。我们假设，大的肿瘤负担可能会抑制远隔效应，从而确保 CN 促进它。然而，在寡进展期放疗可能会克服免疫耐药性。
