The patient was a 65-year-old male who was referred with right renal mass (8 × 6.7 cm) and swelling of para-aortic lymph nodes in CT in April, 20XX. Additional examinations revealed inferior vena cava invasion, multiple lung
metastases and left iliac bone
metastasis and he was diagnosed with a
renal cell carcinoma (cT4N1M1b).
Pazopanib was administered as the first line treatment for an unresectable
renal cancer.
Nivolumab was then administrated as the 2nd line
therapy due to the
disease progression evaluated in (late) June, 20XX. However, immediately after the first administration of
nivolumab, the patient have a difficulty in walking resulting from
low-back pain, and MRI showed multiple lumbar vertebral
metastases and L2
compression fracture. He was transferred to another hospital for
combined modality therapy including right femoral head replacement and palliative
radiotherapy in August, 20XX.
Nivolumab was resumed since he had stable disease after his return to our hospital, and a total of 20 cycles of
nivolumab treatment was performed. A follow-up CT showed 70% decrease in an initial primary
tumor and
tumor decrease or disappear in metastatic lung and bone
tumors. The primary
tumor was considered surgically resectable, and a radical
nephrectomy was performed in August 20XX +1. Histopathological examination showed with a marked effect of
neoadjuvant therapy and no evidence of viable
tumor cells. We report a case of unresectable
carcinoma that was successfully treated with
nivolumab.