Complete Response of a Patient With Metastatic Sarcomatoid Renal Cell Carcinoma to a Programmed Death-1 Checkpoint Inhibitor

Mouallem, Nemer El; Smith, Steven C.; Paul, Asit K.

doi:10.1200/jop.18.00213

Cited by 6 publications

(6 citation statements)

References 5 publications

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“…At 3 weeks following a single dose of nivolumab, clinical, biological and radiological responses were observed 169 . Similarly, in a 2018 report, a complete response to the PD1 checkpoint inhibitor nivolumab was reported in a 67-year-old man with clear cell sRCC who initially experienced disease progression after a 4-month treatment of combination sunitinib plus gemcitabine 170 . At 1 month after starting nivolumab the patient experienced partial resolution of metastatic sites and at 6 months of treatment PET-CT showed complete resolution of all known metastatic disease.…”

Section: High-dose Il-2mentioning

confidence: 75%

“…At 1 month after starting nivolumab the patient experienced partial resolution of metastatic sites and at 6 months of treatment PET-CT showed complete resolution of all known metastatic disease. Nivolumab was continued for 2 years and PET-CT at that time showed no evidence of recurrence 170 . In a 2019 report, 2 patients with sRCCs with documented amplifications of PDL1 at 9p24.1 were reported to have a dramatic response to immunotherapy 99 .…”

Section: High-dose Il-2mentioning

confidence: 99%

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Sarcomatoid renal cell carcinoma: biology, natural history and management

et al. 2020

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Renal cancers are estimated to be diagnosed in 73,750 people in the USA in 2020, and to contribute to 14,830 deaths 1. The 2018 GLOBOCAN report on the global incidence of renal cancers has described 403,262 patients with renal cancer, and 175,098 deaths caused by renal cancers worldwide 2,3. Approximately 90% of all diagnosed renal parenchymal malignancies are renal cell carcinomas (RCCs) 4. A rare transformation called sarcomatoid dedifferentiation can occur in most RCC histological subtypes and portends an especially poor prognosis. RCCs in which sarcomatoid dedifferentiation has occurred are commonly referred to as sarcomatoid RCCs (sRCCs), and patients with sRCCs often present with advanced or metastatic disease and rarely survive >1 year 5-7. Sarcomatoid features are present in approximately 4-5% of all RCCs 8-11. However, this proportion can range from 1 to 29% depending on the primary histology and the reporting study 7,9-13. Although infrequently diagnosed in the localized setting (~20-40% of all sRCCs) 14,15 , approximately 20% of patients with metastatic RCC harbour sarcomatoid dedifferentiation 15. Patients commonly present with an sRCC at between 54 and 63 years of age 6,7,13,14,16,17 , and the male-to-female ratio ranges from 1.3:1 to 2:1 (refs 6,13,14,18,19). Similar to all other RCCs, the mechanisms underlying this gender difference remain unclear. However, possibilities include historical gender differences in occupational exposure or smoking habits, or the influence of sex hormones on tumour biology 20. The natural history and prognosis of sRCCs are poor, as approximately 60-80% of patients present with advanced or late-stage disease 14,15. Median survival is approximately 6-13 months and a higher percentage of sarcomatoid dedifferentiation on histology has been reported to confer a worse prognosis 6,7,11,21,22. Retrospective reports have shown reduced overall survival and cancer-specific survival in patients with increased sarcomatoid features 11,21. Compared with patients without sarcomatoid features, patients with ≥25% sarcomatoid features had ~30% increased overall risk of dying of any cause (HR 2.07, P = 0.048) 11 and those with ≥30% sarcomatoid features had a 52% increased risk of

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Section: High-dose Il-2mentioning

confidence: 75%

Section: High-dose Il-2mentioning

confidence: 99%

Sarcomatoid renal cell carcinoma: biology, natural history and management

et al. 2020

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“…In a retrospective review of patients with sarcomatoid RCC treated with immunotherapy versus chemotherapy, a triple improvement in the median PFS in the immunotherapy group and no difference in OS was observed (9). In a single case report, a notably durable remission of about 2 years was seen in a patient who received nivolumab (10). Our patient achieved an ongoing 4-year remission after treatment with pembrolizumab.…”

Section: Discussionmentioning

confidence: 59%

Durable Remission with Immunotherapy in a Patient with Sarcomatoid Renal Cell Carcinoma

Anusim

Damilola

Afolayan‐Oloye

et al. 2021

jkcvhl

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Sarcomatoid differentiation is a rare and aggressive histologic subtype with poor prognosis, seen in several malignancies. In sarcomatoid renal cell carcinoma (RCC), the degree of sarcomatoid differentiation and the stage at presentation determines the prognosis. Despite resection, chemotherapy and targeted therapy response is modest, with relapse usually occurring within a few months. We present a case of a gentleman with sarcomatoid RCC managed with pembrolizumab, who has had no evidence of recurrence for over 4 years since the last dose of immunotherapy. RCCs with sarcomatoid differentiation have a high presence of programmed cell death protein 1 and programmed cell death ligand 1 in T cells and tumor cells, respectively, making immunotherapy an attractive option in this setting. Clinical trials are ongoing to further define the benefit of immunotherapy in sarcomatoid RCC.

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“…It is important to mention that our study included a period prior to the approval of ICI-based therapies in RCC and, therefore, does not reflect the impact of CN in the immunotherapy era in this aggressive disease. Preliminary results of ICI-based combinations in patients with sRCC are promising [ 17 - 19 ]. Therefore, a well-designed prospective randomized study of the effects of CN on patient outcomes in the immunotherapy era is eagerly awaited.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, an overwhelming majority of these trials only included patients whose disease had clear cell histology. Recent data have shown the benefits of ICI-based combination therapies in patients with metastatic sRCC [ 17 - 19 ]. This led to the recommendation of ICI-based combination therapy for metastatic sRCC by the Society of Immunotherapy of Cancer [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

The Role of Cytoreductive Nephrectomy and Targeted Therapy on Outcomes of Patients With Metastatic Sarcomatoid Renal Cell Carcinoma: A Population-Based Analysis

Al-Juhaishi¹,

Deng²,

Bandyopadhyay³

et al. 2022

Cureus

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Sarcomatoid renal cell carcinoma (sRCC) is a rare but aggressive form of kidney cancer with a poor prognosis. Despite recent advances in therapies for kidney cancers, an effective management strategy for sRCC is uncertain. We evaluated the impact of targeted therapy and cytoreductive nephrectomy (CN) on survival outcomes of patients with metastatic sRCC. We identified patients diagnosed with sRCC between January 1, 1973, and December 31, 2014, within the Surveillance, Epidemiology and End Results (SEER) database. Patients with metastatic sRCC were stratified based on the era of diagnosis (before or after the introduction of targeted systemic therapy in 2006) and the status of CN. Cancer-specific survival (CSS) and overall survival (OS) were analyzed. Data of 993 patients with metastatic sRCC were available for analysis. The median age was 62 years. Most patients were male (69%), Caucasian (71%), and were diagnosed in the targeted therapy era (83%); 53% of patients underwent CN. CSS and OS of the whole cohort were 5.0 months and 4.0 months, respectively. While the introduction of targeted therapy did not improve outcomes, CN improved CSS and OS in both pre-targeted therapy and targeted therapy era. On multivariable analysis, CN was a predictor of an improved CSS (hazard ratio [HR] 0.54, p < 0.0001) and OS (HR 0.51, p < 0.0001). Among other factors, older age at diagnosis, higher T stages, and node positivity were associated with worse outcomes. Our results showed that the introduction of targeted therapy did not improve outcomes in patients with metastatic sRCC. CN improved survival in both pre-targeted and targeted therapy eras.

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Complete Response of a Patient With Metastatic Sarcomatoid Renal Cell Carcinoma to a Programmed Death-1 Checkpoint Inhibitor

Cited by 6 publications

References 5 publications

Sarcomatoid renal cell carcinoma: biology, natural history and management

Sarcomatoid renal cell carcinoma: biology, natural history and management

Durable Remission with Immunotherapy in a Patient with Sarcomatoid Renal Cell Carcinoma

The Role of Cytoreductive Nephrectomy and Targeted Therapy on Outcomes of Patients With Metastatic Sarcomatoid Renal Cell Carcinoma: A Population-Based Analysis

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