# 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

## TL;DR

A patient with advanced kidney cancer achieved complete resection after treatment with lenvatinib and pembrolizumab, followed by robotic surgery.

## Contribution

This case demonstrates successful use of combination therapy to make previously unresectable kidney cancer operable.

## Key findings

- Combination therapy with lenvatinib and pembrolizumab rendered the tumor resectable.
- Post-treatment surgery showed no viable cancer cells in the lymph nodes.
- Robot-assisted radical nephrectomy was successfully performed after six months of treatment.

## Abstract

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.

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.

Combination therapy comprising lenvatinib and pembrolizumab for unresectable papillary renal cell carcinoma may effectively allow radical resection and deferred cytoreductive nephrectomy.