Karibe Jurii, Horiguchi Ryohei, Hanajima Yohei, Hashizume Akihito, Takamoto Daiji, Kawahara Takashi, Osaka Kimito, Teranishi Jun-Ichi, Ueda Naohisa, Uemura Hiroji
Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan.
Department of Neurology, Yokohama City University Medical Center, Yokohama, Japan.
Case Rep Oncol. 2025 Apr 4;18(1):563-569. doi: 10.1159/000545733. eCollection 2025 Jan-Dec.
Immune checkpoint inhibitors are the mainstay of treatment for unresectable or metastatic renal cell carcinoma (RCC). However, they can cause immune-related adverse events (irAEs), and the management of these irAEs is critical. The combination of myasthenia gravis, myositis, and myocarditis, which are irAEs, is rare, and it has not been reported to occur with avelumab. This report aimed to present a rare case of RCC metastasis that developed irAEs during avelumab and axitinib combination therapy.
A 76-year-old woman who underwent radical nephrectomy for clear cell RCC (pT1bN0M0 Grade 3 INFb) at the age of 67 years presented to our hospital after her family doctor noted a pancreatic tumor. She was diagnosed with pancreatic metastasis of RCC based on histopathological examination, and avelumab and axitinib combination therapy was initiated. She developed irAEs, including myasthenia gravis, myositis, and myocarditis, which were treated with steroid pulse therapy. The patient recovered after treatment and was discharged without sequelae.
Myasthenia gravis, myositis, and myocarditis can occur during avelumab and axitinib combination therapy for RCC. Prompt diagnosis, treatment, and collaboration with other departments are extremely important for managing irAEs.
免疫检查点抑制剂是不可切除或转移性肾细胞癌（RCC）治疗的主要手段。然而，它们可引发免疫相关不良事件（irAE），对这些irAE的管理至关重要。重症肌无力、肌炎和心肌炎这三种irAE同时出现的情况较为罕见，且尚未有阿维鲁单抗治疗引发此类情况的报道。本报告旨在呈现一例罕见的RCC转移病例，该病例在接受阿维鲁单抗和阿昔替尼联合治疗期间出现了irAE。
一名76岁女性，67岁时因透明细胞RCC（pT1bN0M0 3级INFb）接受了根治性肾切除术。在其家庭医生发现胰腺肿瘤后，她前来我院就诊。根据组织病理学检查，她被诊断为RCC胰腺转移，并开始接受阿维鲁单抗和阿昔替尼联合治疗。她出现了包括重症肌无力、肌炎和心肌炎在内的irAE，接受了类固醇冲击治疗。患者治疗后康复出院，无后遗症。
在RCC的阿维鲁单抗和阿昔替尼联合治疗期间，可能会出现重症肌无力、肌炎和心肌炎。对于irAE的管理，及时诊断、治疗以及与其他科室协作极为重要。
