Remarkable effect of presurgical nivolumab on originally inoperable papillary renal cell carcinoma with tumor thrombus in inferior vena cava

For the long-term survival of a patient with renal cell carcinoma and a vena cava tumor thrombus, total resection is desired: inoperable patients are sometimes treated with drugs. The effect of the presurgical use of nivolumab, an anti-programmed cell death 1 (PD-1) antibody drug, has been described. Our patient had inoperable renal cancer with an inferior vena cava tumor thrombus. We were able to downsize the tumor to operable size by administrating nivolumab. The patient underwent a nephrectomy and thrombectomy safely. Pathological findings revealed papillary renal cell carcinoma type 2. No viable cells were identified in the removed thrombus. Anti-programmed cell death ligand 1 was expressed on the cell membrane in approximately 20% of the tumor cells, and PD-1 positive tumor-ifiltrating immune cells had infiltrated particularly at the edge of the tumor. This case indicates the positive effect of the presurgical use of nivolumab for advanced papillary renal cell carcinoma.