连续的免疫靶向手术治疗使晚期肾细胞癌患者获得无病生存。
Sequential immune-targeted surgical therapy resulted in disease-free survival in a case with advanced renal cell carcinoma.
机构信息
Department of Urology, Ehime University, Shitsukawa, Toon, Ehime, 791-0295, Japan.
Department of Urology, National Hospital Organization Shikoku Cancer Center, Minamiumemoto, Matsuyama, 791-0280, Japan.
出版信息
BMC Urol. 2021 Sep 8;21(1):124. doi: 10.1186/s12894-021-00891-8.
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.
背景
目前，免疫疗法适用于转移性肾细胞癌或不可切除的肾细胞癌患者，但在新辅助治疗中没有免疫疗法的适应证。我们报告了一例联合使用纳武利尤单抗和伊匹单抗以及序贯 TKI 治疗使手术成为可能的病例。
病例介绍
一名 71 岁女性被诊断为转移性透明细胞肾细胞癌伴 IV 级肿瘤血栓。她开始接受纳武利尤单抗-伊匹单抗治疗，但因肿瘤血栓在右心房内进展而改为单独使用帕唑帕尼治疗。序贯治疗使肿瘤缩小至可切除状态。随后，她接受了右肾切除术和血栓切除术。病理分析显示，原发肿瘤中有 10-20%的肿瘤残留，但血栓中没有存活的细胞。手术后 1 年，她仍处于临床无疾病状态。
结论
该病例提示序贯免疫靶向治疗作为晚期肾细胞癌新辅助治疗的有效性。
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