Tom 9, Nr 3 (2024)
Obrazy w medycynie
Opublikowany online: 2024-06-04

dostęp otwarty

Wyświetlenia strony 55
Wyświetlenia/pobrania artykułu 74
Pobierz cytowanie

Eksport do Mediów Społecznościowych

Eksport do Mediów Społecznościowych

Combined immunotherapy for renal-cell carcinoma (RCC) in geriatric patients

Artur Drobniak1, Łukasz Stokłosa123, Renata Pacholczak-Madej145
Biuletyn Polskiego Towarzystwa Onkologicznego Nowotwory 2024;9(3):263.

Streszczenie

Brak

Obrazy w onkologii / Pictures in oncology

Biuletyn Polskiego
Towarzystwa Onkologicznego
NOWOTWORY

2024, tom 9, nr 3, 263

© Polskie Towarzystwo Onkologiczne

ISSN: 2543–5248, e-ISSN: 2543–8077

www.nowotwory.edu.pl

Combined immunotherapy for renal-cell carcinoma (RCC) in geriatric patients

Artur Drobniak1Łukasz Stokłosa123Renata Pacholczak-Madej145
1Department of Chemotherapy, The District Hospital, Sucha Beskidzka, Poland
2Department of Chemotherapy, The Specialistic Hospital, Nowy Targ, Poland
3Department of the Thoracic Surgery, Pulmonary Hospital, Zakopane, Poland
4Department of Gynecological Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, Krakow, Poland
5Department of Anatomy, Jagiellonian University, Medical College, Krakow, Poland

Jak cytować / How to cite:

Drobniak A, Stokłosa Ł, Pacholczak-Madej R. Combined immunotherapy for renal-cell carcinoma (RCC) in geriatric patients. NOWOTWORY J Oncol 2024; 74: 239.

Combined immunotherapy with nivolumab and ipilimumab has become the standard first-line therapy for intermediate and poor-risk patients with RCC specifically those with clear cell (ccRCC) and sarcomatous components. However, in a pivotal CheckMate 214 trial [1], the median age was 62, and patients 65 years did not benefit. An octogenarian patient with ccRCC presented to our Unit. A CT confirmed the disease stage as cT3aN1M1 (fig. 1 A, B). The patient was unsuitable for nephrectomy due to biological age and advancement of the disease. According to the prognostic criteria of the IMDC [2], the patient fell into the intermediate-risk group (time from diagnosis to treatment <1 year and KS <80%). He was qualified for combined immunotherapy, adhering to the criteria of the National Drug Program (NDP). The initial treatment cycles were well-tolerated, with no significant treatment-related adverse events (trAEs). The CT scan performed after 4 cycles of nivolumab (3 mg/kg every 3 weeks) and ipilimumab (1 mg/kg every 3 weeks), revealed PR per the iRECIST criteria. Subsequently, the patient experienced general malaise (G1 CTCAE), kidney injury (G2), and hepatotoxicity (G2), which did not preclude the continuation of maintenance monotherapy with nivolumab (480 mg every 4 weeks per protocol). These trAEs were successfully managed with treatment interruption. In summary, the patient received 11 cycles (4 in combination and 6 in monotherapy) with stable disease per iRECIST in the last CT scan (fig. 1 C, D). This case highlights that chronological age alone should not be a direct contraindication for combined immunotherapy, as it may offer improved outcomes with manageable trAEs also in the elderly population.

Figure 1. A baseline CT revealed a 96-mm-sized primary tumor in the left kidney and a metastatic tumor in the left lung (A, B). The best overall response with reduction in diameter in both target lesions (C, D)

References

  1. Motzer RJ, McDermott DF, Escudier B, et al. CheckMate 214 investigators, CheckMate 214 Investigators. Nivolumab plus Ipilimumab versus Sunitinib in Advanced Renal-Cell Carcinoma. N Engl J Med. 2018; 378(14): 1277–1290, doi: 10.1056/NEJMoa1712126, indexed in Pubmed: 29562145.
  2. Heng DYC, Xie W, Regan MM, et al. External validation and comparison with other models of the International Metastatic Renal-Cell Carcinoma Database Consortium prognostic model: a population-based study. Lancet Oncol. 2013; 14(2): 141–148, doi: 10.1016/S1470-2045(12)70559-4, indexed in Pubmed: 23312463.