The Changing Face of Lung Cancer: Oligometastatic Renal Metastasis Post Chemo-Immunotherapy Combination

Abstract

This report describes a rare case of oligometastatic renal disease in a 69 year-old Caucasian male with non-small cell lung cancer (NSCLC). Diagnosed with Stage IIIb, NSCLC he completed chemoradiotherapy followed by 1 year of immunotherapy. Surveillance CT scans after nearly three years showed an ill-defined lesion in the left kidney. Biopsy results were consistent with metastasis from the known lung carcinoma. Following neo-adjuvant Pembrolizumab (200mg, q3w), the patient underwent a left radical nephrectomy, without complications. One year post-operatively, CT of the thorax, abdomen and pelvis (TAP) did not identify any recurrence. Renal metastases were historically demonstrated predominantly by autopsy studies^[1]. Any mass manifesting in the kidney in the context of previous NSCLC warrants comprehensive investigations. The combination of immunotherapy followed by definitive treatment appears to be a promising management strategy^[2]. With regards to local curative options, the advantages and disadvantages of surgery and radiotherapy have been well described^[3-4].

Learning points: With improved treatment strategies for advanced malignancies, rare cases will continue to emerge and thus, maintaining a high index of suspicion is fundamentalThis case demonstrates that immunotherapy increases the efficacy of definitive treatment.

Keywords: Oligometastatic renal disease; immunotherapy; nephrectomy; squamous NSCLC.

Figure 1

Computer tomography of patient’s abdomen showing left renal metastasis, Coronal and Axial views