Wong Ryan, Rose Tracy L, Tan Hung-Jui, Hansen Christina, Wobker Sara E, A Bjurlin Marc
Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA.
Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
SAGE Open Med Case Rep. 2025 Jan 1;13:2050313X241311317. doi: 10.1177/2050313X241311317. eCollection 2025.
Clear cell renal cell carcinoma is the predominant subtype of kidney cancer. With distant metastasis, the overall survival rate for patients with renal cell carcinoma decreases significantly compared to localized disease. However, pembrolizumab plus axitinib combination is safe and improves long-term survival. Herein, we report a case of a pathological complete response from systemic pembrolizumab plus axitinib therapy in a 57-year-old male with locally advanced renal cell carcinoma with extensive kidney, inferior vena cava, and hepatic invasion, as well as metastatic disease to the retroperitoneal lymph nodes and lung. After 2-years of systemic treatment, there was absent radiographic evidence of renal cell carcinoma in the lung. The patient underwent right radical nephrectomy, adrenalectomy, partial hepatectomy, and inferior vena cava ligation. Pathology indicated no evidence of tumor consistent with a pathological complete response. This case highlights the possibility of a pathological complete response with pembrolizumab plus axitinib in metastatic renal cell carcinoma and potential disparate findings between radiological response and pathological response.
透明细胞肾细胞癌是肾癌的主要亚型。发生远处转移时，与局限性疾病相比，肾细胞癌患者的总生存率显著降低。然而，帕博利珠单抗联合阿昔替尼治疗是安全的，并能提高长期生存率。在此，我们报告一例57岁男性局部晚期肾细胞癌患者，该患者伴有广泛的肾脏、下腔静脉及肝脏侵犯，以及腹膜后淋巴结和肺转移，接受帕博利珠单抗联合阿昔替尼全身治疗后出现病理完全缓解。经过2年的全身治疗，肺部没有肾细胞癌的影像学证据。患者接受了右肾根治性切除术、肾上腺切除术、部分肝切除术和下腔静脉结扎术。病理检查表明没有肿瘤证据，符合病理完全缓解。该病例突出了帕博利珠单抗联合阿昔替尼在转移性肾细胞癌中实现病理完全缓解的可能性，以及放射学反应和病理反应之间可能存在的不同结果。
