PDF(Pubmed)
Abstract：
In Colombia, renal cancer is a rare condition, with clear cell renal cell carcinoma (ccRCC) being the most prevalent neoplasm. In recent years, immune checkpoint inhibitors (ICI) have been proposed for the management of metastatic disease, as they have shown improved rates of response and long-term survival. Furthermore, they exhibit a favourable tolerance profile, and adverse events causing significant morbidity are infrequent. We report the case of a 61-year-old male patient initially diagnosed with early-stage ccRCC who underwent right nephrectomy in 2009. Six years later, disease recurrence with metastatic compromise was documented, which led to the resection of the L1 vertebral body followed by radiotherapy and maintenance treatment with sunitinib. Due to disease progression, treatment with sunitinib was discontinued. Subsequently, everolimus was initiated as second-line immunotherapy, which was later discontinued due to the appearance of new metastatic lesions. In 2017, the patient was referred to our institution, where a third-line pharmacological treatment with nivolumab was initiated. In 2022, complete remission by positron emission tomography-computed tomography (PET-CT) was evidenced, which has been sustained to date. This case demonstrates the efficacy and safety of ICI in patients with metastatic ccRCC. The case presented is relevant in that it describes the achievement of complete remission in a patient who did not respond to the first two lines of immunotherapy. Given the limited literature regarding the discontinuation of therapy after achieving sustained remission, further research is warranted to explore this topic.
摘要：
在哥伦比亚,肾癌是一种罕见的疾病，透明细胞肾细胞癌（ccRCC）是最常见的肿瘤。近年来,免疫检查点抑制剂（ICI）已被提出用于治疗转移性疾病，因为他们已经显示出改善的反应率和长期生存率。此外，它们表现出良好的公差轮廓，引起显著发病率的不良事件很少见。我们报告了一名最初诊断为早期ccRCC的61岁男性患者，该患者于2009年接受了右肾切除术。六年后,记录了具有转移性损害的疾病复发，导致L1椎体切除，随后进行放疗和舒尼替尼维持治疗。由于疾病进展,停用舒尼替尼治疗.随后，依维莫司开始作为二线免疫疗法，后来由于出现新的转移性病变而停药。2017年，患者被转诊到我们的机构，开始使用nivolumab进行三线药物治疗。2022年，通过正电子发射断层扫描-计算机断层扫描（PET-CT）证明完全缓解，这一直持续到目前为止。该病例证明了ICI在转移性ccRCC患者中的有效性和安全性。所呈现的病例是相关的，因为它描述了对前两行免疫疗法没有反应的患者的完全缓解。鉴于关于在达到持续缓解后停止治疗的文献有限，需要进一步的研究来探索这个话题。
