Long-term survival with nivolumab in a patient with renal cell carcinoma: a case report and review of the literature

BACKGROUND: Immunotherapy has established itself as the standard treatment for advanced renal cell carcinoma (RCC), being used as a primary option alongside tyrosine kinase inhibitors (TKIs) as well as in later lines of therapy. CASE PRESENTATION: We present the case of a 67-year-old man from Latin America who experienced anemia and fatigue. A physical examination indicated tenderness in the left flank. An abdominal CT scan revealed a mass measuring 60 × 44 mm in the left kidney, while a chest CT displayed multiple nodules in both lungs. The clinical assessment led to a diagnosis of stage IV renal cell carcinoma (T1bN0M1). The patient had cytoreductive nephrectomy performed, followed by 25 months of sunitinib treatment. After the disease progressed, he was treated with everolimus, an mTOR inhibitor, but showed limited response. He then started third-line therapy with nivolumab, an immune checkpoint inhibitor (ICI), achieving a complete response after 48 months of treatment. He remains free of disease to this day. CONCLUSIONS: We present a review of existing literature regarding the application of immunotherapy in this context, focusing on the timing and length of treatment for patients who have shown a clinical response, along with the possible advantages of maintaining immunotherapy treatment even after disease progression. Further research is essential to establish the most effective treatment duration and to pinpoint predictive biomarkers and criteria for selecting patients for tailored therapeutic approaches.