The advent of immune checkpoint inhibition opened new perspectives for patients with recurrent or metastasized renal cell carcinoma. In case of recurrent disease, surgical resection remains the most promising therapeutic option. Surgical resection is associated with improved overall survival and demonstrated curative potential given complete resection of metastases can be performed. This report presents the case of a patient with local recurrence of dedifferentiated sarcomatoid renal cell carcinoma approximately 1 year after initial open lumbar nephrectomy. After initial evaluation, surgical removal was deemed infeasible and an induction therapy with pembrolizumab and lenvatinib was initiated. After 3 months, corresponding to 5 cycles of pembrolizumab, the tumor showed a partial response on imaging control and was successfully resected en bloc. Histopathological examination of the specimen revealed no evidence of viable neoplastic cells. This is the first report describing a complete pathological response of a locally recurrent dedifferentiated sarcomatoid renal cell carcinoma after treatment with pembrolizumab and lenvatinib. Overall, the combination therapy was well tolerated with a maximum Common Terminology Criteria for Adverse Events Level of Two. These findings underline the potential of multimodal therapeutic strategies for recurrent renal cell carcinoma, such as induction therapies to downstage initially nonresectable masses, and highlight the need for prospective studies to allow for evidence-based treatment plans.

中文翻译：

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帕博利珠单抗和乐伐替尼治疗下局部复发性肉瘤样肾细胞癌的降期和病理学完全缓解：病例报告和文献综述。

免疫检查点抑制的出现为复发或转移性肾细胞癌患者开辟了新的前景。如果疾病复发，手术切除仍然是最有希望的治疗选择。手术切除与改善总体生存率相关，并且在可以完全切除转移瘤的情况下证明了治疗潜力。本报告介绍了一名患者的病例，该患者在初次开放腰肾切除术约 1 年后出现去分化肉瘤样肾细胞癌局部复发。初步评估后，认为手术切除不可行，并开始使用派姆单抗和乐伐替尼进行诱导治疗。3个月后，相当于5个周期的pembrolizumab，肿瘤在影像控制上显示出部分缓解，并成功整体切除。标本的组织病理学检查未发现存活肿瘤细胞的证据。这是第一份描述局部复发性去分化肉瘤样肾细胞癌在使用派姆单抗和乐伐替尼治疗后出现完整病理反应的报告。总体而言，联合疗法的耐受性良好，不良事件通用术语标准最高为二级。这些发现强调了针对复发性肾细胞癌的多模式治疗策略的潜力，例如诱导治疗以降低最初不可切除肿块的阶段，并强调需要进行前瞻性研究以制定基于证据的治疗计划。