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Case Reports
. 2020 Jul 7;3(5):215-218.
doi: 10.1002/iju5.12195. eCollection 2020 Sep.

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

Nobuyuki Nakajima  1 , Tatsuo Kano  2 , Kazuya Oda  3 , Takato Uchida  1 , Tatsuya Otaki  1 , Kentaro Nagao  1 , Yuki Shimizu  1 , Masayoshi Kawakami  1 , Hakushi Kim  1 , Masahiro Nitta  1 , Masanori Hasegawa  1 , Yoshiaki Kawamura  1 , Akira Miyajima  1
Affiliations
Case Reports

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

Nobuyuki Nakajima et al. IJU Case Rep. .

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.

Keywords: abscopal effect; immune checkpoint inhibitor; programmed cell death‐1; radiotherapy; renal cell carcinoma.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Course of treatment. 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 in April 2018. In May 2018, the patient was subjected to conventional palliative EBRT.
Fig. 2
Fig. 2
Right iliac bone metastasis. In April 2018, metastasis in the iliac bone was observed by CT scan (arrowhead).
Fig. 3
Fig. 3
CT scan images before and after radiotherapy. The upper row shows CT scan images of lung metastases (left), subcutaneous metastasis (middle) and right renal metastasis (right) before radiotherapy (April 2018). The lower row shows CT scan images after radiotherapy (October 2018).
See this image and copyright information in PMC

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