Nagahisa Chika, Yoshida Kazuhiko, Kondo Hanae, Nakayama Takayuki, Mizoguchi Shinsuke, Minoda Ryo, Fukuda Hironori, Kobari Yuki, Iizuka Junpei, Nagashima Yoji, Ishida Hideki, Takagi Toshio
Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
Department of Urology, Tokyo Women's Medical University, Tokyo, Japan;
Anticancer Res. 2024 Mar;44(3):1317-1321. doi: 10.21873/anticanres.16927.
BACKGROUND/AIM: Lenvatinib plus pembrolizumab combination therapy is a safe and effective treatment for patients with advanced renal cell carcinoma (RCC). However, there are no reports of the use of lenvatinib and pembrolizumab combination therapy for RCC with an inferior vena cava (IVC) tumor thrombus. Herein, we describe a case in which pembrolizumab and lenvatinib combination therapy was effectively used to treat RCC with the IVC tumor thrombus extending to the right atrium.
A 73-year-old man was diagnosed with a right renal tumor with the IVC tumor thrombus extending to the right atrium and multiple pulmonary metastases (cT3cN0M1). Using a computed tomography-guided renal tumor biopsy, the tumor was diagnosed as clear cell RCC. The International Metastatic RCC Database Consortium risk classification was poor according to three risk factors, and lenvatinib and pembrolizumab combination therapy was initiated. The primary renal tumor shrunk, the IVC tumor thrombus that reached the right atrium was reduced from level 4 to level 2, and the lung metastases disappeared 4 months after treatment initiation. Thereafter, a robot-assisted deferred cytoreductive nephrectomy was successfully performed. Pathologically, owing to the preoperative combination therapy, most of the tumor tissue was necrotic; however, some viable cells were present in the primary tumor and IVC tumor thrombus. Eight months following the operation, the patient remains recurrence-free.
Treatment with lenvatinib and pembrolizumab combination therapy led to tumor shrinkage and allowed robot-assisted nephrectomy in a patient with advanced RCC with the IVC tumor thrombus extending to the right atrium, corroborating the efficacy of the treatment.
背景/目的：乐伐替尼联合帕博利珠单抗治疗晚期肾细胞癌（RCC）患者安全有效。然而，尚无乐伐替尼与帕博利珠单抗联合治疗伴下腔静脉（IVC）肿瘤血栓的RCC的报道。在此，我们描述一例帕博利珠单抗与乐伐替尼联合治疗有效用于治疗IVC肿瘤血栓延伸至右心房的RCC病例。
一名73岁男性被诊断为右肾肿瘤伴IVC肿瘤血栓延伸至右心房及多发肺转移（cT3cN0M1）。通过计算机断层扫描引导下的肾肿瘤活检，肿瘤被诊断为透明细胞RCC。根据三个风险因素，国际转移性RCC数据库联盟风险分类为低危，遂开始乐伐替尼与帕博利珠单抗联合治疗。治疗开始4个月后，原发性肾肿瘤缩小，延伸至右心房的IVC肿瘤血栓从4级降至2级，肺转移灶消失。此后，成功进行了机器人辅助延迟减瘤性肾切除术。病理检查显示，由于术前联合治疗，大部分肿瘤组织坏死；然而，原发性肿瘤和IVC肿瘤血栓中仍存在一些存活细胞。术后8个月，患者无复发。
乐伐替尼与帕博利珠单抗联合治疗使一名IVC肿瘤血栓延伸至右心房的晚期RCC患者肿瘤缩小，并得以进行机器人辅助肾切除术，证实了该治疗方法的有效性。
