According to the Global Cancer Observatory, kidney cancer is the 14th most common cancer of the world. Among all kidney cancer, renal cell carcinoma (RCC) accounts for most of the cases. In the localized stage, most cases of RCC can be treated with surgery. However, about 20-40% cases eventually develop metachronous metastasis after surgery. In the past years, many adjuvant therapies for RCC provided no significant benefit, without overall survival improvement. Adjuvant immunotherapy for RCC after surgery was firstly approved on the basis of KEYNOTE-564. In this phase 3 trial, adjuvant pembrolizumab therapy after surgery can improve the overall survival in high risks RCC patients. Here, we presented a case of RCC presenting as body weight loss. He received treatment with radical nephrectomy following adjuvant immunotherapy.

A 60-year-old male with the chief complaint of body weight loss for more than 20 kg and came to our hospital for help. Physical exam revealed right palpable mass over abdomen region. CT was arranged and one 14.9cm tumor mass was noted over right kidney lower pole, in favor of RCC. Due to the above reason, surgical intervention with radical nephrectomy was arranged for him. The pathologic report revealed that it was RCC with sarcomatous differentiation, stage III; the PD-L1 combined positive score (CPS) showed ≥1. Therefore, due to high risk of relapse, adjuvant immunotherapy with pembrolizumab was provided every three weeks for one year.

In the whole hospital course, CT of abdomen was checked every three weeks. Besides, we monitor his thyroid function regularly for fear of adverse effect caused by immunotherapy. No obvious recurrence was noted after one year follow-up.

Kidney cancer is common malignancy disease and easily recurrent even after surgery. The incidence of RCC in Taiwan increased gradually in recent years because of advanced image exam. In the past, surgery is the major therapeutic strategy. In the development of clinical trial of adjuvant immunotherapy, it can provide promising benefit for the advanced kidney cancer patient after surgery.