Department of Urology, Nagano Municipal Hospital, 1333-1, Tomitake, Nagano, Nagano, Japan.
Department of Urology, Nagano Municipal Hospital, 1333-1, Oazatomitake, Nagano, Japan.
J Med Case Rep. 2022 May 18;16(1):193. doi: 10.1186/s13256-022-03426-3.
BACKGROUND: Collecting duct carcinoma and sarcomatoid renal cell carcinoma are tumors with poor prognosis. Immune checkpoint inhibitors have been established as the standard treatment for advanced renal cell carcinoma. Some cases of remission of collecting duct carcinoma and sarcomatoid renal cell carcinoma have been reported using immune checkpoint inhibitor interventions. Specifically, sarcomatoid renal cell carcinoma expresses high levels of programmed death-ligand 1, an immune checkpoint protein, and immune checkpoint inhibitors have been reported to be highly effective for treating sarcomatoid renal cell carcinoma. CASE PRESENTATION: We describe the case of a 70-year-old Japanese male who underwent radical right nephrectomy for a right renal mass identified on computed tomography. The pathological examination demonstrated that the renal mass was urothelial carcinoma and collecting duct carcinoma with sarcomatoid changes, and programmed death-ligand 1 was highly expressed with a tumor proportion score of more than 10%. There was no evident submucosal connective tissue invasion in the urothelial carcinoma component, and collecting duct carcinoma was diagnosed as primary cancer. The tumor-node-metastasis classification was pT3aN0, venous invasion 1, lymphovascular invasion 0, and Fuhrman nuclear grade 4. Two months after the nephrectomy, multiple metastases were observed in both lungs, the right hilar lymph node, and the S6 segment of the right liver lobe. We initiated first-line combination therapy with nivolumab (240 mg, fixed dose) and ipilimumab (1 mg/kg). One day after administration, the patient developed drug-induced interstitial pneumonia, thus we applied steroid injections. After one administration of immunotherapy, the metastatic lesion showed complete response within 6 months, which was maintained after 3 years. CONCLUSION: We report the first case of complete response to a single dose of combination therapy with nivolumab and ipilimumab for metastatic collecting duct carcinoma with sarcomatoid changes and high expression of programmed death-ligand 1. This case suggests high expectations for immune checkpoint inhibitors as treatment for sarcomatoid-transformed renal carcinoma tumors that express high levels of programmed death-ligand 1.
背景:集合管癌和肉瘤样肾细胞癌是预后较差的肿瘤。免疫检查点抑制剂已被确立为晚期肾细胞癌的标准治疗方法。已有报道称,使用免疫检查点抑制剂干预可使集合管癌和肉瘤样肾细胞癌部分缓解。具体而言,肉瘤样肾细胞癌表达高水平的程序性死亡配体 1(一种免疫检查点蛋白),并且已报道免疫检查点抑制剂对肉瘤样肾细胞癌非常有效。
病例介绍:我们描述了一名 70 岁日本男性的病例,他因 CT 检查发现右肾肿块而行根治性右肾切除术。病理检查显示,该肾肿块为尿路上皮癌和伴有肉瘤样改变的集合管癌,程序性死亡配体 1 高度表达,肿瘤比例评分大于 10%。尿路上皮癌成分中无明显黏膜下结缔组织侵犯,诊断为原发性癌症。肿瘤-淋巴结-转移(TNM)分期为 pT3aN0,静脉侵犯 1,脉管侵犯 0,Fuhrman 核分级 4。肾切除术后 2 个月,在双肺、右肺门淋巴结和右肝 S6 段发现多处转移。我们开始使用纳武单抗(240mg,固定剂量)和伊匹单抗联合一线治疗。给药后 1 天,患者发生药物诱导性间质性肺炎,因此我们给予类固醇注射。免疫治疗 1 次后,6 个月内转移病灶完全缓解,3 年后仍维持缓解。
结论:我们报告了首例因高表达程序性死亡配体 1而接受纳武单抗和伊匹单抗联合治疗转移性伴有肉瘤样改变的集合管癌完全缓解的病例。该病例提示,免疫检查点抑制剂有望成为治疗表达高水平程序性死亡配体 1 的肉瘤样转化肾细胞癌肿瘤的有效方法。
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