A case of papillary renal cell carcinoma with para‐aortic lymph node metastasis that was completely resectable after treatment with combination therapy comprising lenvatinib and pembrolizumab and robot‐assisted radical nephrectomy

Abstract

Introduction Combination therapy comprising immune checkpoint inhibitors and molecular targeted therapies can be effective for metastatic non‐clear cell renal cell carcinoma. We describe a patient with metastatic papillary renal cell carcinoma that was completely pathologically resectable after combination treatment comprising lenvatinib and pembrolizumab and robot‐assisted radical nephrectomy. Case presentation A 35‐year‐old man was referred to our department for examination of a renal tumor that was diagnosed as left renal cell carcinoma with lymph node metastasis (cT3aN1M0). Because metastasis affected the renal artery, combination therapy comprising lenvatinib and pembrolizumab was initiated. After 6 months of treatment, the patient underwent robot‐assisted radical nephrectomy. The pathological results indicated papillary renal cell carcinoma with no viable cells in the lymph nodes. Conclusion Combination therapy comprising lenvatinib and pembrolizumab for unresectable papillary renal cell carcinoma may effectively allow radical resection and deferred cytoreductive nephrectomy.

Keywords

• cytoreductive nephrectomy
• lenvatinib
• lymphatic metastasis
• papillary renal cell carcinoma
• pembrolizumab