Multimodal treatment approach with sunitinib, pembrolizumab, bevacizumab, sirolimus, and zoledronic acid for locally advanced clear cell renal cell carcinoma: a case report.

Abstract

Locally advanced renal cell carcinoma (RCC) presents significant therapeutic challenges, particularly in resource-limited settings with restricted access to new therapies. This report describes a new exploratory multimodal therapeutic approach for a patient with locally advanced clear cell RCC (ccRCC) with adrenal and lymph node metastases. A 45-year-old woman presented with an incidentally discovered 9-cm mass in the left kidney, which was later diagnosed as grade-2 ccRCC with adrenal and lymph node involvement. After radical nephrectomy, a multimodal treatment regimen consisting of sunitinib, pembrolizumab, bevacizumab, sirolimus, and zoledronic acid was initiated. Following eight cycles of treatment, computed tomography imaging and ultrasound showed considerable tumor shrinkage, with residual mass decreasing from 22 × 42 mm to 22 × 18 mm, which constituted a "radiologically complete response." The patient had compensatory hypertrophy of the contralateral kidney with preserved renal function. This case illustrates the potential efficacy of a novel multimodal treatment strategy combining targeted therapies, immunotherapy, and bone-modifying agents in a resource-limited setting. Further research is needed to validate this approach in larger, diverse patient cohorts.