Elsevier

Clinical Genitourinary Cancer

Volume 15, Issue 6, December 2017, Pages e1127-e1130
Clinical Genitourinary Cancer

Case Report
Rapid Response to Nivolumab in a Patient With Sarcomatoid Transformation of Chromophobe Renal Cell Carcinoma

https://doi.org/10.1016/j.clgc.2017.05.028Get rights and content

Introduction

Renal cell carcinoma (RCC) includes multiple histological subtypes. The most common subtype is clear cell (80%), with 14% papillary, and 5% chromophobe RCC (CRCC).1 The incidence of sarcomatoid transformation is approximately 8% in the CRCC subtype.2

A recent randomized, open-label, phase III study (CheckMate 025) of nivolumab, an anti-programmed death antibody inhibitor versus everolimus in 821 patients with metastatic clear cell RCC, previously treated with 1 or 2 regimens of antiangiogenic therapy, showed longer overall survival and fewer Grade 3 or 4 adverse events with nivolumab than with everolimus.3 However, no prospective clinical trials have been published regarding the use of nivolumab in non–clear-cell RCC (ncc-RCC).

We present a rare case of a patient with metastatic CRCC with sarcomatoid transformation who was given nivolumab as a second-line treatment.

Section snippets

Case

A 52-year-old man, with a history of chronic ischemic heart disease and dyslipidemia, presented to the urology clinic with left flank pain. Computed tomography (CT) imaging of the abdomen revealed a tumor mass with a diameter of 3.5 cm in the left kidney, with no evidence of metastatic disease. He underwent left nephrectomy in December 2009. Pathologic study revealed RCC, chromophobe type, 3.5 cm in maximal diameter, nuclear grade 3. All surgical margins were free of tumor.

In February 2016,

Discussion

Compared with clear cell RCC, patients with CRCC present less frequently with metastatic disease, which leads to better survival. Patients with metastatic CRCC show a high prevalence of sarcomatoid features and poor prognosis.4

Nivolumab is a fully human immunoglobulin G4 programmed death (PD)-1 immune checkpoint inhibitor antibody that selectively blocks the interaction between PD-1 and PD-1 ligand (PD-L) 1 and 2.3

In the CheckMate trial, which included only patients with RCC with a clear-cell

Conclusion

We report a rare case of metastatic CRCC with sarcomatoid transformation treated with nivolumab as second-line therapy with a rapid response to treatment. Future study with nivolumab is warranted in patients with ncc-RCC.

Disclosure

K.R. has lectured for BMS and Novartis. The remaining authors have stated that they have no conflicts of interest.

Acknowledgments

The authors thank David B. Geffen, MD for his critical review of the manuscript.

References (10)

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    Furthermore, RCCs with sarcomatoid dedifferentation show higher PD-L1 expression and higher density of PD-1- and CD8-positive cells compared with grade 4 RCCs without sarcomatoid changes.15 Indeed, emerging clinical experience suggests that immune checkpoint therapy may be a particularly attractive option for RCCs with sarcomatoid dedifferentiation.11,16,17 However, not all RCC histologies with sarcomatoid dedifferentiation consistently respond to immune checkpoint inhibition.

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