Abstract

Over time, works from oncologists and scientists have contributed to the development of systemic therapies for metastatic renal cell carcinoma (mRCC) with contemporary studies showing superior disease free and overall survival benefits in mRCC patients treated with tyrosine kinase inhibitors (TKI) combined with immune checkpoint inhibitors (ICI). The role of cytoreductive nephrectomy is however still controversial. Here we present with a 57-year-old female patient who suffered from mRCC with left renal vein tumor thrombus, left adrenal, right upper lobe lung and left hip metastases. After 6 months of combination systemic therapy with cabozantinib plus nivolumab, the patient achieved a partial response and received robot assisted laparoscopic cytoreductive nephrectomy (CN). Pathology report of the primary tumor in the left kidney was 85% necrotic and the resected specimens involving the left renal vein thrombus and left adrenal revealed exclusively necrotic tissues. Three months postoperative, an image study showed no evidence of recurrence. Radical nephrectomy after neoadjuvant cabozantinib plus nivolumab in selected patients may achieve disease free status.

Keywords:Renal cell carcinoma; Immunotherapy; Nephrectomy; Cytoreduction surgical procedure

Keywords:mRCC: Metastatic Renal Cell Carcinoma; TKI: Tyrosine Kinase Inhibitor; ICI: Immune Checkpoint Inhibitor; CN: Cytoreductive Nephrectomy; CT: Computed Tomography; ORIF: Open Reduction and Internal Fixation; IMDC: Metastatic RCC Database Consortium, SWOG: Southwest Oncology Group, EORTC: European Organization for the Research and Treatment of Cancer, EAU: European Association of Urology