Metastatic renal cell carcinoma regains sensitivity to tyrosine kinase inhibitor after nivolumab treatment: A case report

Abstract

Sequential therapy using tyrosine kinase inhibitors (TKIs) and mammalian target of rapamycin inhibitors is the mainstay of treatment for metastatic renal cell carcinoma. Recently, anti-programmed death-1 (PD-1) antibody, a type of immune checkpoint inhibitor, was approved for use against metastatic renal cell carcinoma. In the present report, two cases of TKI-refractory metastatic renal cell carcinoma which regained sensitivity to TKI after immunotherapy with nivolumab were described. In one case, a third challenge with axitinib after nivolumab treatment resulted in tumor shrinkage, although the second challenge with axitinib immediately before nivolumab treatment had no effect. In another case, a second challenge with pazopanib after nivolumab slightly reduced lung metastasis, which was refractory to pazopanib before nivolumab treatment. These cases suggest that nivolumab can influence the response to subsequent TKI treatment. Case reportCase 1. A 56-year-old Japanese woman with multiple lung nodules on chest X-ray was referred to our hospital in 2012. Computed tomography (CT) disclosed bilateral renal tumors and bilateral adrenal, hepatic, lung, and lymph node metastases. Based on a biopsy of a renal tumor, RCC was diagnosed

A novel definition of microvessel density in renal cell carcinoma: Angiogenesis plus vasculogenic mimicry

“…The clinical significance and cost-effectiveness of this novel concept of TMVD require to be further investigated, not only in the setting of RCC, but also in other cancer types in which VM may have a critical role. Recently, novel combinational therapy targeting other molecules, including programmed cell death 1 (PD1)/programmed cell death 1 ligand 1 (PDL1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), has demonstrated promising efficiency ( 73 – 75 ). With more clinical trials ongoing, it is possible that checkpoint immunotherapy combined with anti-angiogenesis therapy may be adopted as the first-line treatment for metastatic RCC, and PD1/PDL1/CTLA-4 expression levels, and perhaps other gene expression levels ( 76 – 79 ), combined with TMVD may provide higher accuracy in predicting patient prognosis.…”

Cabozantinib as the causative agent of high-grade fever in a patient with a background of metastatic clear cell renal cell carcinoma: a case report

“…Lastly, there are some reports in the literature suggesting that immunotherapy may generate sensitisation to TKI therapy through the use of for example, Nivolumab in RCC patients [17]. This raises the possibility that sensitisation associated with sequencing of treatment in our patient with pembrolizumab prior to cabozantinib may have led to more profound TKI-related sequelae.…”

<p>Organ-Specific Therapeutic Effect of Paclitaxel and Carboplatin Chemotherapy After Platinum-Based Chemotherapy and Pembrolizumab for Metastatic Urothelial Carcinoma</p>

“…In recent years, unexpected effects have been reported regarding cases of further treatment after ICI in various carcinomas, with chemotherapy as well as molecular-targeted therapy reported to demonstrate marked efficacy in this setting. [12][13][14][15] Unexpected responses to cisplatin rechallenge after treatment with immune checkpoint inhibitors have been also reported in patients with metastatic UC refractory to platinum regimens. 7 Since metastatic UC has a severe prognosis (patients tend to have a poor PS, and most die after second-line treatment), resulting in insufficient time to assess the therapeutic effect of re-administration of the same regimen, another regimen chemotherapy is typically selected at our institution.…”