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J Immunother Cancer. 2017 Aug 15;5(1):62. doi: 10.1186/s40425-017-0267-9.

Predictive role of PD-L1 expression in the response of renal Medullary carcinoma to PD-1 inhibition.

Author information

1
Department of Medicine, Augusta University, 1120 15th St, Augusta, GA, 30912, USA.
2
Department of Radiology, Augusta University, 1120 15th St, Augusta, GA, 30912, USA.
3
Department of Pathology, Augusta University, 1120 15th St, Augusta, GA, 30912, USA.
4
Department of Medicine, Augusta University, 1120 15th St, Augusta, GA, 30912, USA. jparikh@augusta.edu.
5
Hematology oncology section, Augusta University, 1120 15th St, Augusta, GA, 30912, USA. jparikh@augusta.edu.

Abstract

BACKGROUND:

Renal medullary carcinoma is one of the rarest malignancies arising from the kidney. Despite various aggressive therapeutic regimens, mortality remains significantly high (95%) with a median overall survival of 5 months. Furthermore, the scarcity of this malignancy renders randomized clinical trials impossible. We examined the expression of programmed death ligand 1 (PD-L1) in two new renal medullary carcinoma cases, investigated their responses to the PD-L1 inhibitor nivolumab and explored the predictive role of the rate of PD-L1 expression in such response.

CASE PRESENTATION:

Two African-American patients (male and female) with sickle cell trait who presented to our center with hematuria and flank pain were diagnosed with metastatic renal medullary carcinoma. PD-L1 was expressed at rate of 25% and 60% in patient 1 and 2 respectively. Following nephrectomy, they were started on nivolumab. Patient 1 initially responded to the treatment with regression of metastatic lesions. However, following this early response, patient 1 who has been receiving nivolumab for more than 15 months, was noted to have a disease progression. Patient 2 had disease progression after 3 months of nivolumab therapy.

CONCLUSIONS:

Although PD-L1 is expressed in these patients with renal medullary carcinoma, response to nivolumab was only observed in patient 1 whose tumor has the lowest rate of PD-L1 expression. This may suggest that in RMC, response to PD-L1 inhibition therapy may not correlate with the rate of PD-L1 expression.

KEYWORDS:

Immunotherapy; Nivolumab; Pd-L1; Renal medullary carcinoma; Sickle cell trait

PMID:
28807004
PMCID:
PMC5557570
DOI:
10.1186/s40425-017-0267-9
[Indexed for MEDLINE]
Free PMC Article

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