Rapid symptomatic and radiological response to pembrolizumab–lenvatinib in a 30-year-old man with metastatic sarcomatoid renal cell carcinoma not otherwise specified and extensive osteolytic bone disease

Abstract

Sarcomatoid dedifferentiation and bone metastases characterize an aggressive subset of metastatic renal cell carcinoma (mRCC) with a poor prognosis. Immune- checkpoint inhibitor combinations are the standard first-line therapy, whilst the role of deferred cytoreductive nephrectomy (dCN) remains debated. We report on the case of a 30-year-old man with International mRCC Database Consortium (IMDC)-classified poor-risk mRCC featuring sarcomatoid dedifferentiation and symptomatic osteolytic bone lesions. First-line pembrolizumab–lenvatinib and bone-targeted agents were initiated. Treatment was well tolerated, achieving rapid symptomatic relief and durable disease control. Following durable disease control, the patient underwent dCN. Histopathological analysis confirmed sarcomatoid RCC, not otherwise specified (ypT1b) with extensive necrosis. Pembrolizumab–lenvatinib was resumed 4 weeks postoperatively. Subsequent restaging demonstrated substantial disease stability. This case highlights the efficacy of pembrolizumab–lenvatinib in achieving rapid clinical benefit in sarcomatoid mRCC with symptomatic bone involvement and the opportunity to perform dCN for carefully selected patients after a caseby- case multidisciplinary discussion. Download the Plain Language Summary of this article: https://www.drugsincontext.com/plain-language-summaries/plain-language-summary-rapid-symptomatic-and-radiological-response-to-pembrolizumab-lenvatinib-in-a-30-year-old-man-with-metastatic-sarcomatoid-renal-cell-carcinoma-not-otherwise-specified This article is part of the Special Issue From evidence to the individual patient: pembrolizumab plus lenvatinib in real-world metastatic renal cell carcinoma: https://www.drugsincontext.com/special_issues/from-evidence-to-the-individual-patient-pembrolizumab-plus-lenvatinib-in-real-world-metastatic-renal-cell-carcinoma

The authors' abstract, as published at the source. Drugs in Context, 2026 · DOI ↗