A case of six year survival with combined immunotherapy and antiangiogenesis for refractory ccRCC with brain metastasis
W skrócie
[Preprint - wstępne wyniki] Prezentujemy przypadek 49-letniego mężczyzny z zaawansowanym rakiem nerki, który mimo wcześniejszych niepowodzeń (operacja, chemioterapia ukierunkowana, radioterapia) osiągnął 6-letnie przeżycie dzięki połączeniu immunoterapii i leku bevacizumab hamującego tworzenie nowych naczyń krwionośnych. Leczenie to skutecznie powstrzymywało postęp choroby przez ponad 2 lata z minimalnym obciążeniem ubocznym - pacjent zachował dobrą jakość życia. Wyniki sugerują, że kombinacja immunoterapii z bevacizumabem może być wartościową opcją dla pacjentów z opornym rakiem nerki i przerzutami do mózgu, choć wymagane są dalsze badania kliniczne potwierdzające te obserwacje.
Oryginalny abstract (angielski)
Abstract Background Clear cell renal cell carcinoma (ccRCC) is a common urinary malignancy, with 20%–30% of patients presenting with advanced disease at diagnosis. Those with brain metastasis have a median natural survival under 3 months and poor long-term outcomes after multiple treatment failures. While immune checkpoint inhibitors (ICIs) combined with anti-angiogenic drugs are key therapies for advanced ccRCC, relevant long-term survival data in such refractory patients are limited. Case Presentation This study retrospectively analyzed the clinical data of a 49-year-old male patient with stage IV clear cell renal cell carcinoma (ccRCC). The patient initially presented with pulmonary metastasis and later developed brain metastasis. He underwent surgical resection, two lines of tyrosine kinase inhibitor (TKI) targeted therapy, as well as radiotherapy combined with immunotherapy for brain metastasis, yet all these treatments eventually led to disease progression. Thereafter, the patient received treatment with immune checkpoint inhibitors (ICIs) plus bevacizumab, and we continuously monitored the therapeutic efficacy and safety during follow-up. The patient achieved an overall survival (OS) of 6 years from the initial diagnosis in April 2018 to the latest follow-up. After multiple treatment failures, the combination of ICIs and bevacizumab sustained disease control for over 24 months. Only grade 1 fatigue and secondary epilepsy occurred during treatment, both of which were manageable. No grade 3 or above treatment-related adverse events were observed, and the patient retained a good quality of life throughout the whole treatment period. Conclusion For patients with refractory advanced ccRCC who have failed multiple lines of TKI therapy and present with concurrent brain metastasis, the combinatorial regimen of ICIs plus bevacizumab can achieve long-term disease control and survival benefits. This regimen provides a valuable reference for clinical treatment decision-making in such refractory patient populations. Further prospective clinical trials are warranted to verify its long-term therapeutic efficacy.