# Effect of rechallenge nivolumab in a hemodialysis patient with multiple metastases from a rapidly progressed T1a renal clear cell carcinoma: An autopsy case

## TL;DR

A hemodialysis patient with a rare aggressive kidney cancer showed disease control for 24 months using nivolumab, even after multiple treatments.

## Contribution

Demonstrates the potential of nivolumab rechallenge in hemodialysis patients with rapidly progressing renal cell carcinoma.

## Key findings

- Nivolumab controlled lung metastasis progression for 24 months in a hemodialysis patient.
- Autopsy confirmed extensive lung tumor involvement despite treatment.
- Rechallenge with nivolumab was feasible in a patient undergoing hemodialysis.

## Abstract

Distant metastasis of T1a renal cell carcinoma is rare and whether metastasis is more probable in patients undergoing hemodialysis remains unclear. We report the autopsy case of a patient undergoing hemodialysis with multiple metastases that rapidly progressed from T1a renal cell carcinoma treated with multimodal therapy including nivolumab.

A 70‐year‐old male who underwent hemodialysis was diagnosed with clear cell carcinoma (pT1a, G2) after nephrectomy. Six months post‐surgery, bone and lung metastases appeared and treated with radiotherapy and pazopanib, respectively. Nivolumab was administered as second‐ and fourth‐line treatments for lung metastases. The patient died approximately 60 months after initial diagnosis; however, nivolumab controlled disease progression for 24 months. An autopsy revealed the lung's occupation with clear cell carcinoma tumor tissue.

Nivolumab has potential to control lung metastasis progression. Additionally, rechallenge is possible in patients with renal cell carcinoma undergoing hemodialysis.