Pembrolizumab plus lenvatinib enabling cytoreductive nephrectomy in metastatic chromophobe renal cell carcinoma: a case report

We report the case of a 65-year-old woman diagnosed with metastatic chromophobe renal cell carcinoma, classified as intermediate risk according to IMDC criteria, who presented with a large left renal mass, para-aortic lymphadenopathy and bilateral pulmonary nodules. First-line treatment with pembrolizumab plus lenvatinib achieved a rapid partial response associated with prolonged distant disease control, with significant symptomatic improvement and recovery of daily functioning. Treatment-related toxicities required lenvatinib dose reduction, allowing continued therapy with good tolerability. After approximately 1 year of treatment, isolated local progression of the primary tumour occurred, while metastatic sites remained controlled. Following multidisciplinary evaluation, the patient underwent deferred cytoreductive radical nephrectomy. This case highlights the potential role of immunotherapy–tyrosine kinase inhibitor combinations in rare renal cell carcinoma subtypes, underscores the value of personalized multimodal strategies, including deferred surgery, and emphasizes the importance of proactive toxicity management to preserve long-term treatment benefit and quality of life. Download the Plain Language Summary of this article: https://www.drugsincontext.com/plain-language-summaries/plain-language-summary-pembrolizumab-plus-lenvatinib-enabling-cytoreductive-nephrectomyin-metastatic-chromophobe-renal-cell-carcinoma-a-case-report This article is part of the Special Issue From evidence to the individual patient: pembrolizumab plus lenvatinib in realworld 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