Complete pathological response of bone metastasis in metastatic renal cell carcinoma treated with pembrolizumab plus lenvatinib after surgical debulking and palliative radiotherapy: a case report

Metastatic renal cell carcinoma (mRCC) presents with marked biological heterogeneity, and bone involvement is associated with aggressive disease and limited response to systemic therapies. We report the case of a 33-year-old female patient with clear cell mRCC who developed metastatic progression after undergoing curative-intent surgery, presenting with vertebral bone metastasis at C7 and peritoneal carcinomatosis. First-line treatment with pembrolizumab plus lenvatinib was initiated, leading to a deep and durable response. A radiological complete response was achieved at all metastatic sites, and subsequent surgery confirmed histological complete remission in the bone lesion. Pathologically documented complete responses in bone metastases from RCC are remarkably rare. This case highlights the potential of immune-checkpoint inhibitor–tyrosine kinase inhibitor combinations to induce profound responses even in unfavourable metastatic patterns and supports a multidisciplinary treatment strategy. Download the Plain Language Summary of this article: https://www.drugsincontext.com/plain-language-summaries/plain-language-summary-complete-pathological-response-of-bone-metastasis-in-metastatic-renal-cell-carcinoma-treated-with-pembrolizumab-plus-lenvatinib-after-surgical-debulking-and-palliative-radio This article is part of the Special Issue From evidence to the individual patient: pembrolizumab plus lenvatinib in real-world metastatic renal cell carcinoma: https://www.drugsincontext.com/special_issues/from-evidence-to-the-individual-patient-pembrolizumab-plus-lenvatinib-in-real-world-metastatic-renal-cell-carcinoma