ニボルマブ投与により著明な免疫関連有害事象と, 中止後の持続的腫瘍縮小を認めた転移性腎細胞癌の1例

Abstract

A 70-year-old female with metastatic clear cell renal cell carcinoma was treated with nivolumab. After three dosages, she developed interstitial lung disease which required steroid therapy and nivolumab was discontinued. Thereafter, the target lesion continued to shrinkand the best response was partial response 15 weeks after discontinuation of nivolumab, the reduction rate of which eventually reached 49.1%. Other immune-related adverse events (irAEs), nephrotic syndrome and acute kidney injury developed 34 weeks after discontinuation of nivolumab, leading to irreversible kidney injury that required chronic hemodialysis. Although the target lesion continued to shrink, a new lesion developed 48 weeks after discontinuation of nivolumab. Subsequently, targeted therapies were added, but she died of cancer 13 months after resuming medical treatment. In this case, although various irAEs developed, the effectiveness of nivolumab was sustained even after it was discontinued.