Complete response to combination therapy using nivolumab and ipilimumab for metastatic, sarcomatoid collecting duct carcinoma presenting with high expression of programmed death-ligand 1: a case report

• Published in: Journal of medical case reports Vol. 16; no. 1; p. 193
• Main Authors: Fuu, Takayoshi, Iijima, Kazuyoshi, Kusama, Yukiko, Otsuki, Toshiaki, Kato, Haruaki
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 18.05.2022; BioMed Central; BMC
• Subjects: Aged; B7-H1 Antigen; Bladder cancer; Cancer; Cancer therapies; Carcinoma; Carcinoma, Renal Cell - pathology; Carcinoma, Transitional Cell; Case Report; Case reports; Cell cycle; Chemotherapy; Collecting duct carcinoma; Combination therapy; Humans; Immune Checkpoint Inhibitors; Immune-related adverse events; Immunotherapy; Ipilimumab; Ipilimumab - therapeutic use; Kidney cancer; Kidney Neoplasms - drug therapy; Kidney Neoplasms - pathology; Kinases; Ligands; Liver cancer; Lymphatic system; Male; Medical imaging; Medical prognosis; Metastasis; Monoclonal antibodies; Neoplasms, Second Primary - drug therapy; Nivolumab - therapeutic use; Patients; Pneumonia; Prognosis; Programmed death-ligand 1; Response rates; Sarcoma; Sarcomatoid renal cell carcinoma; Soft Tissue Neoplasms - drug therapy; Targeted cancer therapy; Urinary Bladder Neoplasms - drug therapy; Case report; Immune checkpoint inhibitors; Immune-related adverse events; Collecting duct carcinoma; Programmed death-ligand 1; Sarcomatoid renal cell carcinoma
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-022-03426-3

Collecting duct carcinoma and sarcomatoid renal cell carcinoma are tumors with poor prognosis. Immune checkpoint inhibitors have been established as the standard treatment for advanced renal cell carcinoma. Some cases of remission of collecting duct carcinoma and sarcomatoid renal cell carcinoma have been reported using immune checkpoint inhibitor interventions. Specifically, sarcomatoid renal cell carcinoma expresses high levels of programmed death-ligand 1, an immune checkpoint protein, and immune checkpoint inhibitors have been reported to be highly effective for treating sarcomatoid renal cell carcinoma. We describe the case of a 70-year-old Japanese male who underwent radical right nephrectomy for a right renal mass identified on computed tomography. The pathological examination demonstrated that the renal mass was urothelial carcinoma and collecting duct carcinoma with sarcomatoid changes, and programmed death-ligand 1 was highly expressed with a tumor proportion score of more than 10%. There was no evident submucosal connective tissue invasion in the urothelial carcinoma component, and collecting duct carcinoma was diagnosed as primary cancer. The tumor-node-metastasis classification was pT3aN0, venous invasion 1, lymphovascular invasion 0, and Fuhrman nuclear grade 4. Two months after the nephrectomy, multiple metastases were observed in both lungs, the right hilar lymph node, and the S6 segment of the right liver lobe. We initiated first-line combination therapy with nivolumab (240 mg, fixed dose) and ipilimumab (1 mg/kg). One day after administration, the patient developed drug-induced interstitial pneumonia, thus we applied steroid injections. After one administration of immunotherapy, the metastatic lesion showed complete response within 6 months, which was maintained after 3 years. We report the first case of complete response to a single dose of combination therapy with nivolumab and ipilimumab for metastatic collecting duct carcinoma with sarcomatoid changes and high expression of programmed death-ligand 1. This case suggests high expectations for immune checkpoint inhibitors as treatment for sarcomatoid-transformed renal carcinoma tumors that express high levels of programmed death-ligand 1.