Neoadjuvant lenvatinib and pembrolizumab for metastatic clear cell renal cell carcinoma: A potential opportunity for complete pathologic and radiographic response.

A 70-year-old man with a 9.1 cm infiltrative right renal mass involving the inferior vena cava (IVC), with retroperitoneal lymphadenopathy and pulmonary nodules, received 27 months of lenvatinib and 6 months of pembrolizumab after biopsy confirmed metastatic clear cell renal cell carcinoma (ccRCC). Restaging imaging demonstrated a reduction of the renal mass to 3.6 cm, resolution of IVC thrombus, lymphadenopathy, and pulmonary metastases. He underwent right robotic cytoreductive radical nephrectomy. Final pathology was ypT0Nx. To our knowledge, this is the first reported case of complete pathologic and radiographic response of metastatic ccRCC predominantly on lenvatinib, with brief duration of pembrolizumab.