Possible abscopal effect after discontinuation of nivolumab in metastatic renal cell carcinoma

Abstract

Introduction Renal cell carcinoma has been considered radioresistant. Recently, several studies have reported the efficacy of combination therapy using radiotherapy and immune checkpoint inhibitors. Case presentation In 1999, a 56‐year‐old woman underwent left nephrectomy (clear cell carcinoma, pT1bN0M0). Seventeen years postoperatively, recurrence in the left lung hilum was observed. Despite administration of three molecular target drugs, all treatments were terminated due to adverse events. Nivolumab was initiated in December 2016. In August 2017, subcutaneous and lung metastases were observed. Moreover in January 2018, right renal metastasis was noted. After 22 cycles of nivolumab treatment, metastasis in the iliac bone was observed, and the patient was subjected to conventional palliative external beam radiation therapy. Five months after radiotherapy, there was significant reduction in multiple metastases. Here, we reported the case presenting with possible abscopal effect. Conclusion Radiotherapy combined with immune checkpoint inhibitors may induce systemic effects against metastatic renal carcinoma.

Editorial Comment from Dr Yuasa to Possible abscopal effect after discontinuation of nivolumab in metastatic renal cell carcinoma

“…2 In this issue of IJU Case Reports, Nakajima et al reported a possible abscopal effect of radiation therapy after discontinuation of nivolumab in mRCC. 3 In this report, a patient with mRCC of International mRCC Database Consortium intermediate risk underwent targeted therapy using pazopanib, axitinib, and everolimus. Consequently, nivolumab was administered as fourth-line therapy.…”

“…Consequently, nivolumab was administered as fourth-line therapy. 3 A right iliac bone metastasis that appeared after the completion of nivolumab therapy was treated with radiation therapy (30 Gy, 10 fractions). 3 Five months after radiotherapy, significant reductions were observed in multiple metastases (lung, right kidney, and subcutaneous tissue).…”

“…3 A right iliac bone metastasis that appeared after the completion of nivolumab therapy was treated with radiation therapy (30 Gy, 10 fractions). 3 Five months after radiotherapy, significant reductions were observed in multiple metastases (lung, right kidney, and subcutaneous tissue). Nine months after radiotherapy, no progression was noted even though no additional systemic therapy was administered.…”

“…Nine months after radiotherapy, no progression was noted even though no additional systemic therapy was administered. 3 RCC has historically been considered intrinsically radioresistant, and the radioresistance has been verified through in vitro experiments, which demonstrated that the RCC cell line was amongst the most radioresistant. 4 Very recently, however, at the 2020 American Society of Clinical Oncology Genitourinary Cancers Symposium, two phase II trials evaluating the combination of immune and radiation therapies in mRCC were presented.…”

Editorial Comment from Dr Kojima to Possible abscopal effect after discontinuation of nivolumab in metastatic renal cell carcinoma

“…The article by Nakajima et al reported that the patient with advanced RCC who showed the tumor reduction in nonirradiated metastases at 9 months after nivolumab discontinuation. 2 There are only a few case series describing the abscopal effect by sequential treatment with nivolumab and RT in patients with advanced RCC. This report indicates that RT and anti-PD1 antibody combination therapy is a possible treatment option for metastatic RCC.…”