Successful treatment of a hemodialysis patient with advanced renal cell carcinoma with nivolumab plus ipilimumab immunotherapy： A case report

Abstract

The patient was a 66‒year‒old male with a 35‒year history of undergoing hemodialysis due to end‒stage kidney dysfunction induced by chronic glomerulonephritis. Computed tomography performed due to a chief complaint of constipation incidentally revealed the presence of a right renal tumor, multiple lung nodules, a tumor embolism affecting the renal vein and inferior vena cava, abdominal lymph node metastases, and bone metastases. A clinical diagnosis of metastatic renal cell carcinoma (RCC), cT3bN2M1 was made. The patient was classified as having a poor risk status according to the International Metastatic RCC Database Consortium (IMDC) risk classification. He was started on combined immune checkpoint blockade therapy with nivolumab and ipilimumab. After four courses, the right renal tumor, lung nodules, venous tumor embolism, lymph node metastases, and bone metastases had all decreased in size, indicating a partial response (PR). After nine courses, the PR was maintained. As for immune‒related adverse events, the patient only experienced grade 2 hypothyroidism at the end of the second course of treatment, which quickly resolved after oral medication was administered. Combined immune checkpoint blockade using nivolumab and ipilimumab was therefore found to be a safe and effective treatment for metastatic RCC in this long‒term hemodialysis patient.