Immunotherapy with Autoimmune Complication in Renal Cancer.

Area of Science:

• Oncology
• Immunotherapy
• Nephrology

Background:

• Checkpoint inhibitors, such as pembrolizumab, are increasingly used in oncology.
• Immune-related adverse events (irAEs) are common with immunotherapy and require prompt management.
• Metastatic renal cell carcinoma (RCC) poses a significant treatment challenge.

Observation:

• A 72-year-old male with metastatic RCC developed autoimmune hepatitis and thyroiditis during pembrolizumab and axitinib therapy.
• The patient presented with fatigue, weakness, and drowsiness, with elevated TSH and transaminases.
• Autoimmune complications were treated with steroids and levothyroxine.

Findings:

• Successful treatment of irAEs allowed for immunotherapy re-challenge.
• After 12 cycles of pembrolizumab, the patient achieved a complete metabolic response with no evidence of lung lesions on PET-CT.
• This case highlights the efficacy of immunotherapy in advanced RCC and the importance of managing its unique side effects.

Implications:

• Prompt diagnosis and treatment of immunotherapy-induced autoimmune complications are crucial for patient management.
• Re-challenging with immunotherapy after managing irAEs can lead to significant clinical benefit and complete remission.
• This approach offers a viable strategy for patients with advanced malignancies receiving checkpoint inhibitor therapy.