Failure of the PD-1 blocking agent pembrolizumab to benefit a patient with renal squamous cell cancer
  • Salman Khan
    Department of Internal Medicine, Staten Island University Hospital/Northwell Health, New York, USA
  • Ekrem Yetiskul
    Department of Internal Medicine, Staten Island University Hospital/Northwell Health, New York, USA
  • Georges Khattar
    Department of Internal Medicine, Staten Island University Hospital/Northwell Health, New York, USA
  • Araji Ghada
    Department of Internal Medicine, Staten Island University Hospital/Northwell Health, New York, USA
  • Sarah Afif
    Department of Internal Medicine, Staten Island University Hospital/Northwell Health, New York, USA
  • Malik Waleed Zeb Khan
    Yale University School of Medicine, New Haven, USA
  • Umesh Manchandani
    Department of Internal Medicine, Staten Island University Hospital/Northwell Health, New York, USA

Keywords

Squamous cell carcinoma, renal cancer, PD-L1, pembrolizumab, neoplasm

Abstract

Introduction: Renal squamous cell carcinoma (SCC) is a neoplasm with an extremely rare occurrence compared to other renal malignancies. The classic presentation includes a palpable mass and flank pain; however, the presentation is seldom non-specific. Our study describes the significance of programmed death ligand-1 (PD-L1) expression in renal cancer and its association with clinical outcomes, alongside available treatment options.
Case description: An 80-year-old female with a history of hypertension and cerebral aneurysm presented with right flank pain and blood in urine and was diagnosed with pyelonephritis and left renal mass/phlegmon. A biopsy revealed SCC of the kidney with metastasis to the lung and aortocaval lymph node. Positron emission tomography (PET) scan confirmed malignancy in the kidney and lung. Treatment with pemrolizumab and carboplatin plus paclitaxel was initiated but poorly tolerated as the haemoglobin dropped rapidly.
Conclusion: SCC poses a diagnostic challenge due to its rarity and non-specific symptoms, often leading to advanced stage diagnosis. PD-L1 expression is pivotal in assessing tumour aggressiveness and prognosis. PD-L1 inhibitors offer promise, but their efficacy in renal SCC warrants further investigation. Radical nephrectomy and systemic chemotherapy show potential in advanced cases, necessitating vigilant management of treatment-related side effects. This case emphasises the need for ongoing research to refine therapeutic approaches and enhance outcomes in renal SCC patients.

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References

  • Li MK, Cheung WL. Squamous cell carcinoma of the renal pelvis. J Urol 1987;138:269–271.
  • Chang K, Qu Y, Dai B, Zhao JY, Gan H, Shi G, et al. PD-L1 expression in Xp11.2 translocation renal cell carcinoma: indicator of tumor aggressiveness. Sci Rep 2017;7:2074.
  • Powles T, Tomczak P, Park SH, Venugopal B, Ferguson T, Symeonides SN, et al. KEYNOTE-564 investigators. Pembrolizumab versus placebo as post-nephrectomy adjuvant therapy for clear cell renal cell carcinoma (KEYNOTE-564): 30-month follow-up analysis of a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol 2022;23:1133–1144. Erratum in: Lancet Oncol 2023;24:e10.
  • Fasano G, Pabon IM, Longhitano Y, Zanza C, Carlidi G, Ravera E, et al. Pembrolizumab-related side effects: acute renal failure and severe neurological toxicity. Medicina (Kaunas) 2022;58:209.
  • Haas NB, Manola J, Uzzo RG, Flaherty KT, Wood CG, Kane C, et al. Adjuvant sunitinib or sorafenib for high-risk, non-metastatic renal-cell carcinoma (ECOG-ACRIN E2805): a double-blind, placebo-controlled, randomised, phase 3 trial. Lancet 2016;387:2008–2016.
  • Holmäng S, Lele SM, Johansson SL. Squamous cell carcinoma of the renal pelvis and ureter: incidence, symptoms, treatment and outcome. J Urol 2007;178:51-56.
  • Thompson RH, Gillett MD, Cheville JC, Lohse CM, Dong H, Webster WS, et al. Costimulatory B7-H1 in renal cell carcinoma patients: Indicator of tumor aggressiveness and potential therapeutic target. Proc Natl Acad Sci USA 2004;101:17174–17179.
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    Published: 2024-06-27
    Issue: 2024: Vol 11 No 7 (view)


    How to cite:
    1.
    Khan S, Yetiskul E, Khattar G, Ghada A, Afif S, Khan MWZ, Manchandani U. Failure of the PD-1 blocking agent pembrolizumab to benefit a patient with renal squamous cell cancer. EJCRIM 2024;11 doi:10.12890/2024_004619.

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