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Journal of Peking University (Health Sciences) ›› 2026, Vol. 58 ›› Issue (4): 865-871. doi: 10.19723/j.issn.1671-167X.2026.04.026

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Long-term survival achieved with benmelstobart plus anlotinib in a patient with advanced clear cell renal cell carcinoma: A case report

Huichun TIAN1, Jiaran ZHANG2, Juan LI1,*()   

  1. 1. Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute; Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China
    2. Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing 100191, China
  • Received:2026-02-28 Online:2026-08-18 Published:2026-05-19
  • Contact: Juan LI
  • Supported by:
    the CAPTRA-STAR Research Foundation(KY202502055)

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Abstract:

Clear cell renal cell carcinoma (ccRCC) is the most common histological subtype of renal cell carcinoma. Patients classified as intermediate- or poor-risk according to the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC), particularly those with multiple organ metastases, generally have an unfavorable prognosis. Here, we report a case of advanced ccRCC in an IMDC poor-risk patient who achieved an unexpectedly prolonged survival with combination therapy followed by maintenance immunotherapy. A 65-year-old male developed multiple metastases involving the lungs, liver, and bone shortly after undergoing radical nephrectomy for right-sided renal cancer. Laboratory findings revealed anemia, neutrophilia, and thrombocytosis, and the IMDC score was 5, indicating poor-risk disease. The patient received first-line treatment with the programmed death-ligand 1 (PD-L1) inhibitor benmelstobart in combination with the multi-target tyrosine kinase inhibitors (TKIs) anlotinib. After 6 weeks of therapy, radiological evaluation demonstrated a partial response (PR), with an overall tumor reduction of approximately 48%. Subsequent imaging assessments confirmed a durable PR, accompanied by significant improvement in clinical symptoms and performance status. During treatment, the patient developed progressive proteinuria, with a maximum 24-hour urinary protein level of 5.18 g. Despite stepwise dose reduction of anlotinib, proteinuria recurred, necessitating discontinuation of the TKIs. Following cessation of anlotinib, the patient continued benmelstobart monotherapy as maintenance therapy and maintained sustained deep remission. After approximately 3 years of treatment, serum creatinine levels gradually increased, reaching a peak of 228 μmol/L. Considering the possibility of treatment-related renal toxicity and the durable disease control achieved, immunotherapy was subsequently discontinued. No further antitumor treatment was administered. The patient eventually experienced disease progression and died in September 2024, with an overall survival of 44 months. This case suggests that the combination of benmelstobart and anlotinib can induce rapid and durable antitumor responses in patients with IMDC poor-risk advanced ccRCC. Notably, in patients who respond well to combination therapy, discontinuation of TKIs due to intolerable adverse events followed by maintenance immunotherapy may still provide long-term disease control. This sustained benefit may be associated with tumor microenvironment remodeling and the establishment of immunological memory induced by anti-angiogenic therapy. Furthermore, this case highlights the importance of vigilant monitoring of renal toxicity and individualized treatment adjustment during combined targeted therapy and immunotherapy.

Key words: Clear cell renal cell carcinoma, Immunotherapy, Targeted therapy

CLC Number: 

  • R737.11

Figure 1

Baseline chest and abdominopelvic CT before treatment A, multiple bilateral pulmonary metastases (largest 14 mm×13 mm); B, multiple hepatic lesions with enhancement, partially confluent (largest 64 mm×56 mm); C, right psoas metastasis (21 mm×13 mm); D, osteolytic lesion in the right iliac bone, consistent with metastasis."

Figure 2

Chest and abdominopelvic CT at 6 weeks after treatment A, bilateral pulmonary metastases decreased in size (largest 11 mm ×9 mm); B, hepatic lesions reduced in size with decreased enhancement (largest 58 mm×54 mm); C, right psoas metastasis decreased (16 mm×8 mm); D, osteolytic lesion in the right iliac bone increased in size."

Figure 3

Chest and abdominopelvic CT at 12 weeks after treatment A, bilateral pulmonary metastases further decreased (largest 6 mm×5 mm); B, hepatic lesions further reduced with decreased enhancement (largest 33 mm×23 mm); C, right psoas-adjacent lesion measuring 11 mm×6 mm; D, osteolytic lesion in the right iliac bone remained stable."

Figure 4

Chest and abdominopelvic CT at 24 weeks after treatment A, bilateral pulmonary metastases remained stable, with the largest 6 mm×5 mm; B, hepatic lesions partly stable, with the largest 33 mm×23 mm, with some lesions further decreased from 18 mm×14 mm to 16 mm×9 mm; C, right psoas-adjacent lesion remained stable; D, osteolytic lesion in the right iliac bone remained stable."

Figure 5

Chest CT and abdominopelvic MRI at last follow-up in October 2023, the patient maintained PR A, bilateral pulmonary metastases remained stable, with the largest lesion measuring 6 mm × 5 mm; B, hepatic lesions remained stable, with the largest lesion measuring 33 mm × 23 mm; C, right psoas-adjacent lesion remained stable; D, osteolytic lesion in the right iliac bone remained stable. PR, partial response."

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