A Case of Acalculous Cholecystitis During Lenvatinib Plus Pembrolizumab Therapy for Advanced Renal Cell Carcinoma

IF 0.5 Q4 Medicine

IJU Case Reports Pub Date : 2026-05-29 DOI:10.1002/iju5.70203

Erika Soga, Go Noguchi, Kota Kobayashi, Rio Shibata, Ryosuke Jikuya, Tomoyuki Tatenuma, Mitsuru Komeya, Hiroki Ito, Hisashi Hasumi, Kazuhide Makiyama

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Abstract

Introduction

Lenvatinib plus pembrolizumab is a standard first-line therapy for advanced renal cell carcinoma (RCC), and acute acalculous cholecystitis is a rare adverse event.

Case Presentation

A 60-year-old woman with metastatic TFE3-positive non–clear cell RCC, classified as poor risk by the International Metastatic RCC Database Consortium (IMDC) criteria, started pembrolizumab plus lenvatinib after palliative radiotherapy for cervical spine metastasis. Lenvatinib was initiated at 8 mg and escalated to 12 mg, achieving tumor shrinkage. Nine days after starting cycle 4, she developed fever and right upper quadrant pain. Computed tomography demonstrated gallbladder distension and wall thickening without gallstones, consistent with acute acalculous cholecystitis. Lenvatinib was interrupted, and intravenous piperacillin/tazobactam was administered; her symptoms improved without drainage. Lenvatinib was resumed at 8 mg with pembrolizumab, and no recurrence occurred.

Conclusion

Early recognition and temporary interruption of lenvatinib with antibiotics may allow cautious rechallenge.

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Lenvatinib + Pembrolizumab治疗晚期肾癌期间发生无结石性胆囊炎1例

Lenvatinib + pembrolizumab是晚期肾细胞癌（RCC）的标准一线治疗，急性无结石性胆囊炎是一种罕见的不良事件。一名60岁的女性转移性tfe3阳性非透明细胞RCC，被国际转移性RCC数据库联盟（IMDC）标准归类为低风险，在颈椎转移姑息性放疗后开始使用派姆单抗加lenvatinib。Lenvatinib起始剂量为8mg，逐渐增加到12mg，实现肿瘤缩小。第4周期开始后第9天，患者出现发热和右上腹疼痛。计算机断层扫描显示胆囊膨胀和壁增厚，无胆结石，符合急性无结石性胆囊炎。中断Lenvatinib，静脉给予哌拉西林/他唑巴坦；她的症状在没有引流的情况下有所改善Lenvatinib与pembrolizumab的剂量为8mg，未发生复发。结论对lenvatinib的早期识别和暂时停用抗生素，应谨慎再用药。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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