The Changing Face of Lung Cancer: Oligometastatic Renal Metastasis Post Chemo-Immunotherapy Combination.

Unlabelled: This report describes a rare case of oligometastatic renal disease in a 69 year-old Caucasian male with non-small cell lung cancer (NSCLC). Diagnosed with Stage IIIb, NSCLC he completed chemoradiotherapy followed by 1 year of immunotherapy. Surveillance CT scans after nearly three years showed an ill-defined lesion in the left kidney. Biopsy results were consistent with metastasis from the known lung carcinoma. Following neo-adjuvant Pembrolizumab (200mg, q3w), the patient underwent a left radical nephrectomy, without complications. One year post-operatively, CT of the thorax, abdomen and pelvis (TAP) did not identify any recurrence. Renal metastases were historically demonstrated predominantly by autopsy studies. Any mass manifesting in the kidney in the context of previous NSCLC warrants comprehensive investigations. The combination of immunotherapy followed by definitive treatment appears to be a promising management strategy. With regards to local curative options, the advantages and disadvantages of surgery and radiotherapy have been well described.

Learning Points: With improved treatment strategies for advanced malignancies, rare cases will continue to emerge and thus, maintaining a high index of suspicion is fundamentalThis case demonstrates that immunotherapy increases the efficacy of definitive treatment.