Recurrent TFE3-Rearranged Renal Cell Carcinoma Responding to Pembrolizumab Plus Lenvatinib After Postoperative Pembrolizumab: A Case Report

IF 0.5 Q4 Medicine

IJU Case Reports Pub Date : 2026-10-19 DOI:10.1002/iju5.70280

Masashi Fujimoto, Tomoyasu Sano, Yuta Sano, Satoshi Inoue, Kazuna Matsuo, Tomokazu Kimura, Shohei Ishida, Kenji Zennami, Yoshihisa Matsukawa, Shusuke Akamatsu

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Abstract

Introduction

TFE3-rearranged renal cell carcinoma (RCC) is rare, and evidence guiding systemic therapy is limited.

Case Presentation

A 25-year-old man with gross hematuria had a left renal tumor with hilar lymph node metastasis. Robot-assisted radical nephrectomy and hilar lymph node dissection were performed. Histology, immunohistochemistry, and fluorescence in situ hybridization confirmed TFE3-rearranged RCC, pT3aN1. Postoperative pembrolizumab was started because of the high risk of recurrence. Eight months after surgery, lung and retroperitoneal metastases developed. Lenvatinib was added to ongoing pembrolizumab. The metastatic lesions decreased within one month, and a partial response according to Response Evaluation Criteria in Solid Tumors has been maintained for ten months.

Conclusion

This case suggests that adding a vascular endothelial growth factor receptor tyrosine kinase inhibitor to pembrolizumab may be a therapeutic option for recurrent TFE3-rearranged RCC, although longer follow-up and molecular characterization are needed.

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复发性tfe3重排肾细胞癌对术后派姆单抗联合Lenvatinib有反应：1例报告

简介：tfe3重排肾细胞癌（RCC）是罕见的，指导全身治疗的证据有限。病例介绍：一25岁男性肉眼血尿左肾肿瘤伴肾门淋巴结转移。行机器人辅助根治性肾切除术和肾门淋巴结清扫术。组织学、免疫组织化学和荧光原位杂交证实tfe3重排RCC， pT3aN1。由于复发风险高，术后开始使用派姆单抗。术后8个月，出现肺和腹膜后转移。Lenvatinib被添加到正在进行的派姆单抗中。转移病灶在一个月内减少，根据实体瘤反应评价标准的部分反应维持了10个月。结论：该病例提示，在派姆单抗中添加血管内皮生长因子受体酪氨酸激酶抑制剂可能是复发性tfe3重排RCC的治疗选择，尽管需要更长时间的随访和分子表征。

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