Hyperprogressive Disease In a Metastatic Renal Cell Carcinoma Patient After Receiving Immune Checkpoint Inhibitors: A Case Report

Owing to their survival benefits, immune checkpoint inhibitors (ICIs) have emerged as the mainstay treatment for several types of malignant tumors including renal cell carcinoma (RCC). However, the usage of ICIs such as nivolumab, ipilimumab, and atezolizumab can be complicated by unexpected rapid clinical deterioration and acceleration of tumor growth. This adverse event is called hyperprogressive disease (HPD) with an incidence rate of 10-20%. Since its first description in 2016, efforts have been made to identify and predict this phenomenon. We report a case of a 34-year-old female patient diagnosed with metastatic renal cell carcinoma (mRCC) with sarcomatoid features. She underwent a left radical nephrectomy followed by combination ICIs (nivolumab/ipilimumab) therapy. However, she presented with a rapid clinical deterioration shortly after receiving her second cycle of ICIs. The radiological assessment showed new multiple bilateral lung nodules, new multiple mediastinal and left hilar lymph node involvement, and two focal areas of new appearance involving the left aspect of L3 lumbar vertebrae and left ischial bone. The diagnosis of HPD was made. Unfortunately, the patient died soon following her second infusion of the nivolumab/ipilimumab combination.