# Very Late Recurrence of Clear Cell Renal Cell Carcinoma With Pancreatic and Hepatic Metastases Showing Durable Response to Dual Checkpoint Blockade

## TL;DR

A patient with late recurrence of kidney cancer in the liver and pancreas showed long-term improvement with immunotherapy, despite hormone-related side effects.

## Contribution

Demonstrates durable response to dual checkpoint blockade in very late recurrence of clear cell renal cell carcinoma with pancreatic and hepatic metastases.

## Key findings

- Dual checkpoint blockade with nivolumab and ipilimumab induced a partial response lasting over 30 months.
- Endocrine immune-related adverse events were safely managed with hormone replacement without interrupting treatment.
- The case suggests immunotherapy can provide long-term disease control in very late metastatic clear cell renal cell carcinoma.

## Abstract

Very late recurrence of clear cell renal cell carcinoma with pancreatic involvement is uncommon, and treatment and toxicity management are not well defined. A patient developed liver and pancreatic lesions approximately 18 years after nephrectomy for clear cell renal cell carcinoma. Liver biopsy with immunohistochemistry confirmed metastatic renal origin; the pancreatic mass was diagnosed radiologically. Nivolumab plus ipilimumab (four induction cycles) followed by nivolumab maintenance induced a partial response. During maintenance, the patient experienced an immune‐related endocrine adverse event with secondary adrenal insufficiency and central hypothyroidism, managed with hormone replacement without treatment interruption. Performance status remained excellent, and tumor response has been durable for more than 30 months. This case highlights that endocrine immune‐related adverse events can be safely managed with appropriate hormone replacement, allowing uninterrupted immunotherapy and preserving long‐term benefit. Dual immune checkpoint blockade can achieve durable disease control in very late recurrent clear cell renal cell carcinoma with pancreatic and hepatic metastases, and endocrine toxicity may be safely managed to maintain benefit.

Dual immune checkpoint blockade can achieve long‐term disease control in very late recurrent clear cell renal cell carcinoma involving pancreas and liver, when immune‐related endocrine toxicity is promptly recognized and managed with hormone replacement.