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Case Reports in Immunology
Volume 2018, Article ID 1623957, 4 pages
https://doi.org/10.1155/2018/1623957
Case Report

Efficacy of Nivolumab in a Patient with Metastatic Renal Cell Carcinoma and End-Stage Renal Disease on Dialysis: Case Report and Literature Review

1Department of Oncology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
2Clinical Oncology Department, Assiut University, Asyut, Egypt
3Medical Oncology Department, South Egypt Cancer Institute, Asyut, Egypt

Correspondence should be addressed to Jawaher Ansari; moc.liamg@irasna.kaj

Received 17 January 2018; Revised 18 April 2018; Accepted 15 May 2018; Published 13 June 2018

Academic Editor: Christian Drouet

Copyright © 2018 Jawaher Ansari et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Treatment of patients with metastatic renal cell carcinoma (mRCC) and end-stage renal disease (ESRD) on dialysis poses a therapeutic challenge, particularly as this patient group was excluded from the pivotal clinical trials. In addition, there is uncertainty regarding drug dosing/pharmacokinetics, lack of safety and efficacy data, and potential for increased toxicity when using targeted therapy or immunotherapy for the management of patients with mRCC on dialysis. Nivolumab, an anti-programmed death-1 immune checkpoint inhibitor antibody, is indicated for the treatment of patients with mRCC who have received prior antiangiogenic therapy. Given the above-mentioned uncertainties, clinicians may be reluctant to use nivolumab for this patient population, leading to potential denial of life-prolonging medications. We report the case of a 72-year-old gentleman with mRCC and ESRD on dialysis who received second-line nivolumab therapy and achieved an excellent symptomatic and radiological response, remaining progression-free for over 22 months. In addition, we have reviewed the pharmacokinetic data and published retrospective case studies to review the management options for patients with mRCC and ESRD on dialysis.