Immunotherapy in Dialysis-Dependent Cancer Patients: Our Experience in Patients With Metastatic Renal Cell Carcinoma and a Review of the Literature.

Abstract

Abstract Background In the last few years, several new drugs such targeted therapy and immunotherapy have shown activity and have been approved for the treatment of metastatic renal cell carcinoma (mRCC). In mRCC, nivolumab, anti-PD-1 antibody, has recently been approved for the treatment after failure of anti-angiogenic treatment. Literature data are very limited in some subgroups of patients such as those with end-stage renal disease requiring hemodialysis that were excluded from the pivotal clinical trial. Patients and Methods We retrospectively reviewed the medical records of 8 patients with metastatic renal cell carcinoma undergoing dialysis treated with nivolumab to evaluate the treatment-related toxicities and the clinical outcomes. Results Among 8 patients treated with nivolumab, partial responses were observed in one patient and stable disease in five patients. Therefore, the objective response rate was 12,5%, and the disease control rate was 75%. The estimated median PFS was 16 months (95% CI 1,2 – 30,8 mo). Median overall survival was 26 months (95% CI 9,7 – 42,2 mo). There were no grade 4 adverse events and only 2 patients (25%) had grade 3 adverse events. Conclusions Even though the retrospective nature of this survey and the relatively small sample size represent major limitations, these data indicate that treatment with nivolumab is feasible with no unexpected toxicity and good efficacy in this cohort of patients. These results merit further confirmation by a larger prospective trial.