ArticleCase reports in oncology
Toripalimab in Metastatic Renal Collecting Duct Carcinoma: A Case Report.
Article in Case reports in oncology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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4 authors.
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Abstract
Introduction: Collecting duct carcinoma (CDC), a rare and highly aggressive subtype of renal cell carcinoma (RCC), is often associated with poor prognosis due to its resistance to conventional therapies. Although platinum-based chemotherapy is conventionally regarded as the first-line treatment of metastatic CDC, its clinical benefits are limited. Emerging evidence suggests that CDC shares immunophenotypic and genomic features with urothelial carcinoma, providing a rationale for investigating immune checkpoint inhibitors. Case Presentation: We report the case of a 55-year-old male patient with postoperative metastatic CDC exhibiting a urothelial carcinoma-like immunophenotype. The patient presented with gross hematuria and left flank pain, and imaging revealed a large left renal mass with regional lymph node and pulmonary metastases. Histopathology confirmed CDC, characterized by high nuclear atypia, extensive necrosis, and high Ki-67 proliferation. First-line gemcitabine-cisplatin chemotherapy was discontinued due to grade III gastrointestinal toxicity, leading to imitation of second-line treatment with toripalimab, a programmed death protein 1 (PD-1) inhibitor. The patient achieved a complete response after six cycles of toripalimab, confirmed by the complete resolution of bilateral pulmonary metastases. Immune-related adverse events were managed with temporary treatment interruption, prednisone, and L-thyroxine therapy. Currently, the patient has maintained a progression-free survival of 24 months. Conclusion: This case demonstrates the complete response of metastatic CDC to toripalimab, despite negative PD-L1 expression. This outcome highlights the role of CD8+ T-cell infiltration and IFN-γ pathway activation within the tumor microenvironment in treatment response and the potential efficacy of PD-1 inhibition as a viable therapeutic strategy for this aggressive RCC subtype.
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