Glandular metastases from renal cell carcinoma show poor clinical responses to immune checkpoint inhibition but durable responses to angiogenesis inhibitors.
Daniel R PrincipeBrian C SchulteSuneel D KamathHidayatullah G MunshiPublished in: BMJ case reports (2021)
While half of the metastatic clear cell renal cell carcinomas (ccRCCs) involve the lungs, metastatic lesions have been described in various other organs, including glandular tissues such as the pancreas. Recent evidence suggests that ccRCC lesions affecting the pancreas are poorly responsive to immune checkpoint inhibition (ICI) but show superior responses to tyrosine kinase inhibitors (TKIs) targeting the vascular endothelial growth factor (VEGF) signalling pathway. However, this has yet to be explored in ccRCC spreading to other glandular tissues. Here we present two cases of ccRCC with glandular metastases, the first to the pancreas and the second to the parotid gland. In both patients, ICI-based immunotherapy offered minimal clinical benefit, but both had durable responses to angiogenesis inhibitors. Given the anatomic similarity between the pancreas and parotid glands, ccRCC with involvement of the parotid gland may also benefit from VEGF-targeting TKIs as opposed to ICIs.
Keyphrases
- vascular endothelial growth factor
- endothelial cells
- squamous cell carcinoma
- cancer therapy
- renal cell carcinoma
- gene expression
- end stage renal disease
- small cell lung cancer
- newly diagnosed
- chronic kidney disease
- single cell
- ejection fraction
- drug delivery
- high grade
- prognostic factors
- mesenchymal stem cells
- wound healing
- chronic myeloid leukemia