Efficacy of Nivolumab in a Patient withMetastatic Renal Cell Carcinoma and End-Stage Renal Diseaseon Dialysis: Case Report and Literature Review

Treatment of patients with metastatic renal cell carcinoma (mRCC) and end-stage renal disease (ESRD) on dialysis posesa therapeutic challenge, particularly as this patient group was excluded from the pivotal clinical trials. In addition, there isuncertainty regarding drug dosing/pharmacokinetics, lack of safety and efficacy data, and potential for increased toxicity whenusing targeted therapy or immunotherapy for the management of patients with mRCC on dialysis. Nivolumab, an anti-programmeddeath-1 immune checkpoint inhibitor antibody, is indicated for the treatment of patients with mRCC who have received priorantiangiogenic therapy. Given the above-mentioned uncertainties, clinicians may be reluctant to use nivolumab for this patientpopulation, leading to potential denial of life-prolonging medications. We report the case of a 72-year-old gentleman with mRCCand ESRD on dialysis who received second-line nivolumab therapy and achieved an excellent symptomatic and radiologicalresponse, remaining progression-free for over 22 months. In addition, we have reviewed the pharmacokinetic data and publishedretrospective case studies to review the management options for patients with mRCC and ESRD on dialysis