A Case of Hyperprogression in Metastatic Rcc Following Immunotherapy

Introduction In rare cases, immunotherapy can lead to hyperprogressive disease (HPD), a phenomenon in which a tumour starts growing accelerated. [1] We present a clinical scenario where the treatment of stage IV renal cancer resulted in rapid hyperprogression of the tumour. Case Presentation A 39-year-old male was presented to the emergency room. His complaints included a headache and a mass near the right eyebrow. MRI scan revealed a metastasis in the superolateral corner of the right orbit. CT scan showed multiple metastases in the lungs, a large mass located in the upper third part of the left kidney, and a metastasis in the left adrenal gland. A biopsy of the mass confirmed the final medical diagnosis: stage IV left renal cell carcinoma (RCC) with metastases to the lungs, adrenal gland, and orbit. After an unsuccessful first-line therapy with Sunitinib, oncologists decided that the best next option would be to switch to the second-line therapy with Nivolumab. The patient received four infusions, however, the patient developed progressive dyspnea. Evaluation by radiologists revealed that the patient was experiencing hyperprogression and pulmonary embolism. Discussion This case highlights the therapeutic challenges of metastatic renal cell carcinoma (mRCC) complicated by hyperprogression (HPD). Treatment of mRCC typically involves VEGF inhibitors and immune checkpoint inhibitors (ICI). However, in this case, Nivolumab may have caused the hyperprogression as it is often associated with the acceleration of tumour growth. Therefore physicians need to consider alternative strategies like combination therapies or novel agents targeting the tumor microenvironment. [2] Conclusions We presented a case of a rare phenomenon called hyperprogressive disease. This unexpected outcome of the ICIs immunotherapy occurs in less than 1% of patients with metastatic RCC. [3] Physicians must be knowledgeable and prepared to respond immediately.