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Tailoring Immunotherapy Treatment of Synchronous Renal Cell Carcinoma (RCC) and Triple-Negative Breast Cancer (TNBC)

Tailoring Immunotherapy Treatment of Synchronous Renal Cell Carcinoma (RCC) and Triple-Negative... Hindawi Case Reports in Oncological Medicine Volume 2019, Article ID 6246209, 2 pages https://doi.org/10.1155/2019/6246209 Case Report Tailoring Immunotherapy Treatment of Synchronous Renal Cell Carcinoma (RCC) and Triple-Negative Breast Cancer (TNBC) Iris Y. Sheng, Megan Kruse, Kathryn M. Leininger, and Moshe C. Ornstein Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA Correspondence should be addressed to Moshe C. Ornstein; ornstem@ccf.org Received 23 February 2019; Accepted 15 May 2019; Published 4 June 2019 Academic Editor: Katsuhiro Tanaka Copyright © 2019 Iris Y. Sheng et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Synchronous tumors are defined as two tumors arising concurrently or within six months of each other. Reports of synchronous RCC and breast cancer are limited to nonmetastatic renal cell carcinoma (RCC) and hormone receptor-positive infiltrative ductal carcinoma. We present the first case of synchronous metastatic renal cell carcinoma and metastatic triple-negative breast cancer, managed with a novel combination of immunotherapy and chemotherapy. 1. Introduction mass, new retroperitoneal lymphadenopathy, and worsening osteosclerotic metastasis; capecitabine was discontinued. Synchronous tumors are defined as two tumors arising con- For a clinical trial, breast tissue underwent genomic test- ing and an activating SQSTM1-RET fusion mutation was currently or within six months of diagnosis [1]. Reports of synchronous RCC and breast cancer are limited to nonmeta- revealed. Renal biopsy (to exclude a second primary malig- static RCC and hormone receptor-positive infiltrative ductal nancy) showed clear cell RCC. The genomic analysis of the carcinoma (IDC) treated with complete resection of each pri- renal biopsy did not yield mutations. Ipilimumab and nivolu- mary tumor followed by chemoradiation and hormone ther- mab was started in 5/2018. She developed treatment-related rash, which was resolved with steroids. After 4 cycles of ipili- apy [2, 3]. We present a case of tailored immunotherapy for a patient with concurrent metastatic RCC (mRCC) and triple- mumab/nivolumab (7/2018), CT showed partial response negative breast cancer (TNBC). with a resolution of lung nodules and shrinkage of the RCC primary tumor, enlarging adenopathy and worsening bony metastasis. A clinical breast exam was normal. Given 2. Case Report mixed response, nivolumab maintenance was implemented and nab-paclitaxel was added. CT (10/2018) showed partial A 67-year-old woman presented (10/2017) with right side response with improved adenopathy, stable renal lesion, and stable bony lesions. The patient currently remains on this breast discomfort. Ultrasound demonstrated a 6 1×4 0× 5 8cm mass with no adenopathy, and biopsy showed an combination of nivolumab and nab-paclitaxel with her last CT (Figure 1) showing stable disease (current duration ER-negative, PR-negative, HER2-negative IDC. Staging com- puterized tomography (CT) showed bilateral pulmonary of therapy: 10 months). nodules (all < 3 mm), a 5 cm lower pole left kidney mass, renal vein thrombus, and innumerable sclerotic bone lesions (Figure 1). Bone marrow biopsy confirmed metastatic breast 3. Discussion cancer. In 12/2017, she started taking capecitabine. While follow-up evaluations revealed breast softening, CT after 3 When two synchronous metastatic tumors are diagnosed, cycles of capecitabine showed no response in distant sites. genomic testing can help direct the therapy if overlapping She developed two new pulmonary nodules, enlarging renal mutations exist. In the current case, however, both primary 2 Case Reports in Oncological Medicine (a) (b) Figure 1: Effects of therapy on RCC ((a) pretreatment CT (10/27/2017), (b) posttreatment CT (1/17/2019)) and bony lesions ((a) pretreatment NM bone scan (10/27/2019), (b) posttreatment NM bone scan (1/16/2019)). tumors had different genomic profiles and a more nuanced are uncommon. Individualized approaches, such as that approach was required. employed in this case, in which a novel combination of Unlike TNBC, RCC does not respond well to chemother- immunotherapy and immunotherapy are used, may be criti- apy. To date, there are no immunotherapy agents that dually cal for patient outcomes. treat RCC and breast cancer. However, given emerging data for immunotherapy in TNBC and strong data for the combi- nation of ipilimumab/nivolumab in mRCC, the decision was Conflicts of Interest made to treat both tumors with an immunotherapy approach All authors declare no conflicts of interest. [4]. The patient’s initial response to therapy as highlighted above demonstrated a treatment response in the RCC lesions (kidney and lung nodules) but not in the biopsy-proven References breast cancer lesions in the bone. When the patient’s dis- ease progressed, results from the Impassion130 trial were [1] R. Arjunan, D. Kumar, K. V. V. Kumar, and C. S. Premlatha, released, which showed superior ORR (56% vs. 46%) and “Breast cancer with synchronous renal cell carcinoma: a rare decreased disease progression/death by 20% when nab- presentation,” Journal of Clinical and Diagnostic Research, paclitaxel was added to atezolizumab compared to standard vol. 10, no. 10, pp. XD03–XD05, 2016. chemotherapy in the treatment of TNBC [5]. Thus, we con- [2] O. Üreyen, E. Dadalı, F. Akdeniz et al., “Co-existent breast and tinued the maintenance of nivolumab for the mRCC as per renal cancer,” Turkish Journal of Surgery, vol. 31, no. 4, pp. 238– standard of care but added nab-paclitaxel in the hopes of 240, 2015. obtaining a synergistic antitumor effect for the TNBC. [3] U. A. Kurlekar and A. S. Rayate, “Synchronous primary malig- Historically, the mainstay of anticancer therapy was nancies in breast and kidney: a rare case report,” Indian Journal chemotherapy. Consequently, patients with synchronous of Surgery, vol. 77, Supplement 1, pp. 6–9, 2015. tumors were treated with combination chemotherapy. With [4] R. J. Motzer, N. M. Tannir, D. F. McDermott et al., “Nivolumab progress in research and drug development, the armamentar- plus ipilimumab versus sunitinib in advanced renal-cell carci- ium of therapy has now been expanded to include multiple noma,” New England Journal of Medicine, vol. 378, no. 14, therapeutic agents such as chemotherapy, immunotherapy, pp. 1277–1290, 2018. genomic-directed targeted therapies, and hormonal thera- [5] “ESMO 2018: IMpassion 130: atezolizumab plus nab-paclitaxel pies. While genomic sequencing of synchronous tumors in metastatic triple-negative breast cancer - The ASCO Post,” could provide a single actionable mutation, these instances December 2018, https://www.ascopost.com/News/59387. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Hindawi Publishing Corporation Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 http://www www.hindawi.com .hindawi.com V Volume 2018 olume 2013 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 International Journal of Journal of Immunology Research Endocrinology Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Submit your manuscripts at www.hindawi.com BioMed PPAR Research Research International Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2013 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Neurology Research and Treatment Cellular Longevity Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Case Reports in Oncological Medicine Hindawi Publishing Corporation

Tailoring Immunotherapy Treatment of Synchronous Renal Cell Carcinoma (RCC) and Triple-Negative Breast Cancer (TNBC)

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Hindawi Publishing Corporation
Copyright
Copyright © 2019 Iris Y. Sheng et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ISSN
2090-6706
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2090-6714
DOI
10.1155/2019/6246209
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Abstract

Hindawi Case Reports in Oncological Medicine Volume 2019, Article ID 6246209, 2 pages https://doi.org/10.1155/2019/6246209 Case Report Tailoring Immunotherapy Treatment of Synchronous Renal Cell Carcinoma (RCC) and Triple-Negative Breast Cancer (TNBC) Iris Y. Sheng, Megan Kruse, Kathryn M. Leininger, and Moshe C. Ornstein Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA Correspondence should be addressed to Moshe C. Ornstein; ornstem@ccf.org Received 23 February 2019; Accepted 15 May 2019; Published 4 June 2019 Academic Editor: Katsuhiro Tanaka Copyright © 2019 Iris Y. Sheng et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Synchronous tumors are defined as two tumors arising concurrently or within six months of each other. Reports of synchronous RCC and breast cancer are limited to nonmetastatic renal cell carcinoma (RCC) and hormone receptor-positive infiltrative ductal carcinoma. We present the first case of synchronous metastatic renal cell carcinoma and metastatic triple-negative breast cancer, managed with a novel combination of immunotherapy and chemotherapy. 1. Introduction mass, new retroperitoneal lymphadenopathy, and worsening osteosclerotic metastasis; capecitabine was discontinued. Synchronous tumors are defined as two tumors arising con- For a clinical trial, breast tissue underwent genomic test- ing and an activating SQSTM1-RET fusion mutation was currently or within six months of diagnosis [1]. Reports of synchronous RCC and breast cancer are limited to nonmeta- revealed. Renal biopsy (to exclude a second primary malig- static RCC and hormone receptor-positive infiltrative ductal nancy) showed clear cell RCC. The genomic analysis of the carcinoma (IDC) treated with complete resection of each pri- renal biopsy did not yield mutations. Ipilimumab and nivolu- mary tumor followed by chemoradiation and hormone ther- mab was started in 5/2018. She developed treatment-related rash, which was resolved with steroids. After 4 cycles of ipili- apy [2, 3]. We present a case of tailored immunotherapy for a patient with concurrent metastatic RCC (mRCC) and triple- mumab/nivolumab (7/2018), CT showed partial response negative breast cancer (TNBC). with a resolution of lung nodules and shrinkage of the RCC primary tumor, enlarging adenopathy and worsening bony metastasis. A clinical breast exam was normal. Given 2. Case Report mixed response, nivolumab maintenance was implemented and nab-paclitaxel was added. CT (10/2018) showed partial A 67-year-old woman presented (10/2017) with right side response with improved adenopathy, stable renal lesion, and stable bony lesions. The patient currently remains on this breast discomfort. Ultrasound demonstrated a 6 1×4 0× 5 8cm mass with no adenopathy, and biopsy showed an combination of nivolumab and nab-paclitaxel with her last CT (Figure 1) showing stable disease (current duration ER-negative, PR-negative, HER2-negative IDC. Staging com- puterized tomography (CT) showed bilateral pulmonary of therapy: 10 months). nodules (all < 3 mm), a 5 cm lower pole left kidney mass, renal vein thrombus, and innumerable sclerotic bone lesions (Figure 1). Bone marrow biopsy confirmed metastatic breast 3. Discussion cancer. In 12/2017, she started taking capecitabine. While follow-up evaluations revealed breast softening, CT after 3 When two synchronous metastatic tumors are diagnosed, cycles of capecitabine showed no response in distant sites. genomic testing can help direct the therapy if overlapping She developed two new pulmonary nodules, enlarging renal mutations exist. In the current case, however, both primary 2 Case Reports in Oncological Medicine (a) (b) Figure 1: Effects of therapy on RCC ((a) pretreatment CT (10/27/2017), (b) posttreatment CT (1/17/2019)) and bony lesions ((a) pretreatment NM bone scan (10/27/2019), (b) posttreatment NM bone scan (1/16/2019)). tumors had different genomic profiles and a more nuanced are uncommon. Individualized approaches, such as that approach was required. employed in this case, in which a novel combination of Unlike TNBC, RCC does not respond well to chemother- immunotherapy and immunotherapy are used, may be criti- apy. To date, there are no immunotherapy agents that dually cal for patient outcomes. treat RCC and breast cancer. However, given emerging data for immunotherapy in TNBC and strong data for the combi- nation of ipilimumab/nivolumab in mRCC, the decision was Conflicts of Interest made to treat both tumors with an immunotherapy approach All authors declare no conflicts of interest. [4]. The patient’s initial response to therapy as highlighted above demonstrated a treatment response in the RCC lesions (kidney and lung nodules) but not in the biopsy-proven References breast cancer lesions in the bone. When the patient’s dis- ease progressed, results from the Impassion130 trial were [1] R. Arjunan, D. Kumar, K. V. V. Kumar, and C. S. Premlatha, released, which showed superior ORR (56% vs. 46%) and “Breast cancer with synchronous renal cell carcinoma: a rare decreased disease progression/death by 20% when nab- presentation,” Journal of Clinical and Diagnostic Research, paclitaxel was added to atezolizumab compared to standard vol. 10, no. 10, pp. XD03–XD05, 2016. chemotherapy in the treatment of TNBC [5]. Thus, we con- [2] O. Üreyen, E. Dadalı, F. Akdeniz et al., “Co-existent breast and tinued the maintenance of nivolumab for the mRCC as per renal cancer,” Turkish Journal of Surgery, vol. 31, no. 4, pp. 238– standard of care but added nab-paclitaxel in the hopes of 240, 2015. obtaining a synergistic antitumor effect for the TNBC. [3] U. A. Kurlekar and A. S. Rayate, “Synchronous primary malig- Historically, the mainstay of anticancer therapy was nancies in breast and kidney: a rare case report,” Indian Journal chemotherapy. Consequently, patients with synchronous of Surgery, vol. 77, Supplement 1, pp. 6–9, 2015. tumors were treated with combination chemotherapy. With [4] R. J. Motzer, N. M. Tannir, D. F. McDermott et al., “Nivolumab progress in research and drug development, the armamentar- plus ipilimumab versus sunitinib in advanced renal-cell carci- ium of therapy has now been expanded to include multiple noma,” New England Journal of Medicine, vol. 378, no. 14, therapeutic agents such as chemotherapy, immunotherapy, pp. 1277–1290, 2018. genomic-directed targeted therapies, and hormonal thera- [5] “ESMO 2018: IMpassion 130: atezolizumab plus nab-paclitaxel pies. While genomic sequencing of synchronous tumors in metastatic triple-negative breast cancer - The ASCO Post,” could provide a single actionable mutation, these instances December 2018, https://www.ascopost.com/News/59387. MEDIATORS of INFLAMMATION The Scientific Gastroenterology Journal of World Journal Research and Practice Diabetes Research Disease Markers Hindawi Hindawi Publishing Corporation Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 http://www www.hindawi.com .hindawi.com V Volume 2018 olume 2013 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 International Journal of Journal of Immunology Research Endocrinology Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Submit your manuscripts at www.hindawi.com BioMed PPAR Research Research International Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 Journal of Obesity Evidence-Based Journal of Journal of Stem Cells Complementary and Ophthalmology International Alternative Medicine Oncology Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2013 Parkinson’s Disease Computational and Behavioural Mathematical Methods AIDS Oxidative Medicine and in Medicine Neurology Research and Treatment Cellular Longevity Hindawi Hindawi Hindawi Hindawi Hindawi www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018 www.hindawi.com Volume 2018

Journal

Case Reports in Oncological MedicineHindawi Publishing Corporation

Published: Jun 4, 2019

References