Nivolumab plus ipilimumab was effective against metastatic renal cell carcinoma in a hemodialysis patient with end-stage renal disease

Abstract

The patient was a 69-year-old male. He had been on hemodialysis due to end-stage renal disease caused by diabetic nephropathy for 4 months. He had undergone coronary artery bypass graft surgery 7 years ago. A CT scan performed as part of a routine cardiovascular check-up incidentally revealed a left renal tumor and multiple pulmonary metastases. He was referred to our department. The clinical diagnosis was metastatic renal cell carcinoma (cT1bN0M1, intermediate risk according to the IMDC classification), and immune checkpoint inhibitor combination therapy, involving nivolumab plus ipilimumab, was started. A full therapeutic dose was administered. After 2 courses (6 weeks later), the left renal tumor and pulmonary metastases had decreased in size (a partial response). After 8 courses (18 weeks later), the sizes of the tumors had decreased further. The patient only experienced one adverse effect; i.e., grade 2 hypothyroidism was observed at the end of the 4th course (12 weeks later); however, it was quickly resolved using oral medication. We consider that nivolumab plus ipilimumab combination therapy is acceptable and effective against metastatic renal cell carcinoma in hemodialysis patients with end-stage renal disease.