Efficacy of pembrolizumab plus lenvatinib as first-line treatment for metastatic renal cell carcinoma with multiple brain metastases

Introduction: Patients with metastatic renal cell carcinoma have a poor prognosis and its specific pathogenesis remains unelucidated.

Case presentation: At 78 years of age, a Japanese male patient was diagnosed with metastatic renal cell carcinoma (cT3N2M1 stage) and multiple brain metastases that were responsive to stereotactic radiation therapy followed by systemic combination induction therapy of pembrolizumab plus lenvatinib. Adverse events, including grade 3 hypertension, grade 2 eruption, and elevated grade 2 fever, were controlled by a dose reduction or suspension of drugs. The patient eventually showed a tolerance for continuing with 8 mg lenvatinib. Fourteen months after the initiation of treatment, and on 8 mg lenvatinib, this patient showed no sign of disease progression at the last follow-up.

Conclusion: We detail the absence of disease progression in a metastatic renal cell carcinoma case with multiple brain metastases more than 1 year after stereotactic radiation therapy followed by first-line pembrolizumab plus lenvatinib.