Dr Hammers on a Case Presentation in Advanced RCC

Hans Hammers, MD, PhD, professor, Department of Internal Medicine, member, Division of Hematology and Oncology, inaugural Eugene P. Frenkel, MD Scholar in Clinical Medicine, Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, discusses a case presentation of a patient with advanced renal cell carcinoma (RCC).

This case was of a 48-year-old man who presented with a left renal mass and extensive liver metastases, which were confirmed via biopsy as clear cell RCC, Hammers begins. Initially, this patient’s disease was deemed unresectable, leading to his referral to medical oncology, he states. This patient was initiated on a treatment regimen involving nivolumab (Opdivo) and ipilimumab (Yervoy). During treatment discussions, oncologists and the patient deliberated on potential adverse effects (AEs) associated with the regimen, Hammers explains, noting that the alternative treatment would have been a single-agent TKI.

The patient began immunotherapy and received 2 doses of nivolumab/ipilimumab. However, at the third dose administration, a significant surge in his kidney function tests was observed, prompting the introduction of immune suppression therapy, Hammers says. The overarching takeaway here is that, when faced with uncertainty regarding treatment decisions, prioritizing systemic therapy is crucial, as this approach has gained prominence in recent years, he explains.

Many patients with disease characteristics similar to those of the patient in the case study would likely benefit from a combination of immune checkpoint inhibitors targeting PD-1 and CTLA-4 because of the more favorable long-term outcomes associated with combinations of those agents, Hammers continues. However, it is essential to acknowledge the accompanying spectrum of AEs, he says. Despite the AEs the patient in the case study experienced, the regimen he received had a remarkable therapeutic effect, particularly evident in the regression of liver metastases and the primary tumor, Hammers emphasizes.

After 1 year of therapy and approximately 6 months of immune suppression, the patient achieved a deep and sustained response to nivolumab plus ipilimumab, which prompted a surgical consolidation intervention that found no evidence of metastatic cells in the liver. This patient has surpassed 5 years with no signs of disease recurrence, and received 2 doses of immune checkpoint inhibitors in total, Hammers concludes.