case_images: PMC9895929_01
case_images: PMC9895929_02
case_images: Recurrence after radical left nephrectomy of the patient's with renal clear cell carcinoma. (A) CT scan (August 23, 2021) showed the first recurrence after nephrectomy in 13 years. The red arrow indicates the prominent lesion in the liver, and the blue arrow indicates the pancreatic lesion. (B) Laparoscopic partial hepatectomy was performed for the largest intrahepatic lesions on August 26, 2021, and postoperative pathology confirmed liver metastasis of renal clear cell carcinoma. (C) The images of positron emission tomography CT (PET-CT) on September 09, 2021 showed hypermetabolic pancreatic lesions, no hypermetabolism in the residual liver, and no additional hypermetabolic lesions. (D) Immunohistochemistry showed that PD-L1 expression in the tumor tissue was 40% for tumor proportion score (TPS), CD3+ TIL density was 100 cells/HPF, and CD8+ TIL density was 50 cells/HPF.
case_images: fimmu-14-1115691-g001.jpg
case_images: PMC9895929_03_fimmu-14-1115691-g001.jpg
case_images: f1
case_images: Immunohistochemical staining showed the tumor proportion score (TPS) of PD-L1 expression was 40% according to Allred criteria using the DAKO PD-L1 22C3 PharmDx assay (Agilent Technologies; Carpinteria, CA, USA) ( Figure 1D ).
case_images: PMC9895929_03
case_images: Recurrence after radical left nephrectomy of the patient's with renal clear cell carcinoma. (A) CT scan (August 23, 2021) showed the first recurrence after nephrectomy in 13 years. The red arrow indicates the prominent lesion in the liver, and the blue arrow indicates the pancreatic lesion. (B) Laparoscopic partial hepatectomy was performed for the largest intrahepatic lesions on August 26, 2021, and postoperative pathology confirmed liver metastasis of renal clear cell carcinoma. (C) The images of positron emission tomography CT (PET-CT) on September 09, 2021 showed hypermetabolic pancreatic lesions, no hypermetabolism in the residual liver, and no additional hypermetabolic lesions. (D) Immunohistochemistry showed that PD-L1 expression in the tumor tissue was 40% for tumor proportion score (TPS), CD3+ TIL density was 100 cells/HPF, and CD8+ TIL density was 50 cells/HPF.
case_images: fimmu-14-1115691-g001.jpg
case_images: PMC9895929_03_fimmu-14-1115691-g001.jpg
case_images: f1
case_images: Immunohistochemical staining showed the tumor proportion score (TPS) of PD-L1 expression was 40% according to Allred criteria using the DAKO PD-L1 22C3 PharmDx assay (Agilent Technologies; Carpinteria, CA, USA) ( Figure 1D ).
case_images: PMC9895929_04
case_images: Short-term lenvatinib overcomes primary resistance of mRCC to anti-PD1 therapy. (A) After 3 cycles of pembrolizumab monotherapy, CT scan on November 05, 2021 showed disease progression, the patient was still resistant to the combination of axitinib with pembrolizumab, with significantly enlarged and increased number of metastases in liver (Feb 18, 2022), the addition of lenvatinib to pembrolizumab led to rapid tumor regression shown in a follow-up CT scan on March 16, 2022 (23 days after lenvatinib initiation), CT examination in May 2022 revealed almost complete response (CR) of the intrahepatic and pancreatic lesions, all lesions continued to regress in the two CT scans after lenvatinib was discontinued, with a sustained complete response as shown in the CT scan image on September 29, 2022 and December 02, 2022. (B) Diagram of the patient's entire treatment process, PH representing laparoscopic partial hepatectomy (August 26, 2021), representing lenvatinib dose reduction due to AEs (June 23, 2022). (C) After 1 month of suspension of the use of lenvatinib, the patient's 24-hour urine protein test showed that urine protein gradually returned to normal. (D) After discontinuation of lenvatinib, the patient gradually gained weight.
case_images: fimmu-14-1115691-g002.jpg
case_images: PMC9895929_04_fimmu-14-1115691-g002.jpg
case_images: f2
case_images: After 3 cycles of pembrolizumab, a surveillance CT scan on November 05, 2021 showed disease progression, with several new metastases in liver ( Figure 2A ). After 3-cycle treatment with pembrolizumab plus axitinib, a surveillance CT scan was performed on February 18, 2022, and showed further disease progression with significantly enlarged and increased number of metastases in liver compared with that on November 05, 2021 ( Figure 2A ). A follow-up CT scan in May 16, 2022 (3 months after lenvatinib initiation) showed the metastatic lesions in the liver had significantly decreased in size ( Figure 2A ). The whole process of treatment was shown in  Figure 2B .