Secrets revealed by the skin: initial success of tislelizumab and targeted therapy in advanced renal cell carcinoma-a case report and literature review.

Background: In renal cell carcinoma (RCC), skin metastases (SMs) occur in only 3.3% of cases and are even rarer as an initial manifestation of the disease. Although combination therapy with immune checkpoint inhibitors (ICIs) and targeted agents is the current standard of care, access to these treatments may be limited in certain regions due to cost constraints. Tislelizumab, a structurally enhanced humanized IgG4 monoclonal antibody developed indigenously in China, has demonstrated substantial efficacy and manageable safety profiles in clinical trials across a variety of solid tumors. Case Description: We report the case of a 46-year-old male who initially presented with painless ulcerative skin nodules on his scalp and the tip of his nose. Surgical removal of the scalp nodules led to a pathological diagnosis of metastatic clear cell RCC (ccRCC). Subsequent positron emission tomography/computed tomography (PET/CT) imaging revealed metastases in the lungs, bones, and brain. Due to financial constraints, the patient opted for combination therapy with tislelizumab and sunitinib. After one treatment cycle, the skin nodules resolved, pulmonary metastases decreased in size, and the left renal mass stabilized. However, disease progression (PD) was observed before the start of the twelfth cycle. Conclusions: Our case demonstrates that tislelizumab combined with sunitinib exhibits potential benefits for patients with advanced RCC, particularly in regions where access to standard combination therapy is limited. However, further clinical evidence is needed to support its widespread adoption in routine clinical practice.