ナガシマ ヨウジ   Nagashima, Yoji
  長嶋 洋治
   所属   医学部 医学科(東京女子医科大学病院)
   職種   教授
論文種別 症例報告
言語種別 英語
査読の有無 査読あり
表題 Niborumab therapy for metastatic collecting duct carcinoma after nephrectomy. A case report.
掲載誌名 正式名:Medicine
ISSNコード:13573039/18789390
掲載区分国外
巻・号・頁 97(45),e13173頁
著者・共著者 Yasuoka S, Hamasaki T, Kuribayashi E, Nagashima Y, Kondo Y, Nagasawa M, Kawaguchi T
発行年月 2018/10
概要 RATIONALE:

Collecting duct carcinoma (CDC) is a rare type of nonclear renal cell carcinoma, often presenting at an advanced stage of the disease, and standard treatment guidelines have not been established.
PATIENT CONCERNS:

A 73-year-old man was admitted to our hospital with complaints of fever and lower right back pain.
DIAGNOSES:

Computed tomography revealed a poorly defined tumor of the right kidney without metastasis. The patient underwent right radical nephrectomy and was diagnosed with clinical stage T1bN0M0 renal cancer; the pathological findings showed collecting duct carcinoma.
INTERVENTIONS:

After nephrectomy, multiple lung metastases were found in the following month, so first-line chemotherapy of gemcitabine (1000 mg/m on days 1 and 8, every 21 days) and cisplatin (70 mg/m on day 2, every 21 days) was administered. Due to disease progression, targeted therapy with axitinib (10 mg/body) and second-line chemotherapy of paclitaxel (200 mg/m on day 1, every 21 days) and carboplatin (area under the curve of 6 on day 1, every 21 days) were subsequently administered. However, the lung metastases progressed and new metastases spread to the right adrenal gland, liver, and lymph nodes. Based on the high expression of programmed death-ligand 1 in tumor cells, we treated the patient with the immune checkpoint inhibitor nivolumab.
OUTCOMES:

After 2 courses of treatment, he experienced a partial response and improved performance status, and thus was discharged from the hospital. To date, the patient is on his fifth course of treatment as an outpatient without disease progression.
LESSONS:

The findings of our study suggest that nivolumab may be effective even if the patient has highly progressive CDC with a low PS, if PD-L1 is highly expressed in the tumor cells.
DOI 10.1097/MD.0000000000013173
PMID 30407350