Concurrent Chronic Myeloid Leukemia and Metastatic Renal Cell Carcinoma in a 61-year-old Female Successful Treatment with Low-Dose Immunotherapy and Combination Targeted Therapy
Main Article Content
Keywords
chronic myeloid leukemia, renal cell carcinoma, Nivolumab, Axitinib, dasatinib
Abstract
We report a rare case of a 61-year-old female diagnosed with concurrent Chronic Myeloid Leukemia (CML) and Renal Cell Carcinoma (RCC). The patient had a history of CML treated with imatinib for 4 years, with loss of complete hematological response for 3 months before being diagnosed with RCC and lung metastases. Due to a T315I mutation in the BCR-ABL1 gene, the treatment regimen included a novel combination of Axitinib, Dasatinib, and low-dose nivolumab. The patient showed a remarkable therapeutic response with a complete metabolic response accompanied by a highly significant reduction in the size of the tumor and complete resolution of the metastatic lung lesions, as well as a major molecular response in terms of CML disease control.
References
1. Chen Y, Tortorici MA, Garrett M, Hee B, Klamerus KJ, Pithavala YK. Clinical pharmacology of axitinib. Clin Pharmacokinet. 2013;52(9):713–25. https://doi.org/10.1007/s40262-013-0068-3
2. Hu-Lowe DD, Zou HY, Grazzini ML, Hallin ME, Wickman GR, Amundson K, et al. Nonclinical antiangiogenesis and antitumor activities of axitinib (AG-013736), an oral, potent, and selective inhibitor of vascular endothelial growth factor receptor tyrosine kinases 1, 2, 3. Clin Cancer Res. 2008;14(22):7272–83. https://doi.org/10.1158/1078-0432.CCR-08-0652
3. Rini BI, Plimack ER, Stus V, Gafanov R, Hawkins R, Nosov D, et al. Pembrolizumab plus axitinib versus sunitinib for advanced renal-cell carcinoma. N Engl J Med. 2019;380(12):1116–27. https://doi.org/10.1056/NEJMoa1816714
4. Zibelman MR, Plimack ER, Broderick S, Carducci MA, Ged Y, Molina AM, et al. A phase I/II study of nivolumab and axitinib in patients with advanced renal cell carcinoma. J Clin Oncol. 2022;40(suppl 6):291 (abstract). https://doi.org/10.1200/JCO.2022.40.6_suppl.291
5. Pemovska T, Johnson E, Kontro M, Repasky GA, Welinder E, Mpindi JP, et al. Axitinib effectively inhibits BCR-ABL1 (T315I) with a distinct binding conformation. Nature. 2015;519(7541):102–5. https://doi.org/10.1038/nature14119
6. Deng Q, Wang E, Wu X, Cheng Q, Liu J, Li X. Combination of axitinib with dasatinib improves the outcome of a chronic myeloid leukemia patient with BCR-ABL1 T315I mutation. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2020;45(7):874–80. https://doi.org/10.11817/j.issn.1672-7347.2020.190116
7. Branford S, Melo JV, Hughes TP. Selecting optimal second-line tyrosine kinase inhibitor therapy for chronic myeloid leukemia patients after imatinib failure: Does the BCR-ABL mutation status really matter? Blood. 2009;114(27):5426–35. https://doi.org/10.1182/blood-2009-08-215939
8. Sun J, Wang X, Tang B, Cai Y, Liu J, Shao Z, et al. A tightly controlled Src-YAP signaling axis determines therapeutic response to dasatinib in renal cell carcinoma. Theranostics. 2018;8(12):3256–67. https://doi.org/10.7150/thno.23964
9. Lue HW, Derrick DS, Rao S, Van Gaest A, Cheng L, Podolak J, et al. Cabozantinib and dasatinib synergize to induce tumor regression in non-clear cell renal cell carcinoma. Cell Rep Med. 2021;2(5):100267. https://doi.org/10.1016/j.xcrm.2021.100267
10. Wang Z, Jiang L, Wang X, Yin H, Lv X, Wang Z, et al. Cabozantinib carries the risk of drug-drug interactions via inhibition of UDP-glucuronosyltransferase (UGT) 1A9. Curr Drug Metab. 2022;23(11):912–9. https://doi.org/10.2174/1389200224666221028140652
11. Motzer RJ, Escudier B, McDermott DF, George S, Hammers HJ, Srinivas S, et al. Nivolumab versus everolimus in advanced renal-cell carcinoma. N Engl J Med. 2015;373(19):1803–13. https://doi.org/10.1056/NEJMoa1510665
12. Choueiri TK, Powles T, Burotto M, Escudier B, Bourlon MT, Zurawski B, et al. Nivolumab plus cabozantinib versus sunitinib for advanced renal-cell carcinoma. N Engl J Med. 2021;384(9):829–41. https://doi.org/10.1056/NEJMoa2026982
13. Agrawal S, Feng Y, Roy A, Kollia G, Lestini B. Nivolumab dose selection: Challenges, opportunities, and lessons learned for cancer immunotherapy. J Immunother Cancer. 2016;4:72. https://doi.org/10.1186/s40425-016-0177-2
14. Dutcher JP, Wiernik PH. Renal cell carcinoma in patients with a personal or family history of hematologic malignancies. Clin Adv Hematol Oncol. 2015;13(6):392–7.
2. Hu-Lowe DD, Zou HY, Grazzini ML, Hallin ME, Wickman GR, Amundson K, et al. Nonclinical antiangiogenesis and antitumor activities of axitinib (AG-013736), an oral, potent, and selective inhibitor of vascular endothelial growth factor receptor tyrosine kinases 1, 2, 3. Clin Cancer Res. 2008;14(22):7272–83. https://doi.org/10.1158/1078-0432.CCR-08-0652
3. Rini BI, Plimack ER, Stus V, Gafanov R, Hawkins R, Nosov D, et al. Pembrolizumab plus axitinib versus sunitinib for advanced renal-cell carcinoma. N Engl J Med. 2019;380(12):1116–27. https://doi.org/10.1056/NEJMoa1816714
4. Zibelman MR, Plimack ER, Broderick S, Carducci MA, Ged Y, Molina AM, et al. A phase I/II study of nivolumab and axitinib in patients with advanced renal cell carcinoma. J Clin Oncol. 2022;40(suppl 6):291 (abstract). https://doi.org/10.1200/JCO.2022.40.6_suppl.291
5. Pemovska T, Johnson E, Kontro M, Repasky GA, Welinder E, Mpindi JP, et al. Axitinib effectively inhibits BCR-ABL1 (T315I) with a distinct binding conformation. Nature. 2015;519(7541):102–5. https://doi.org/10.1038/nature14119
6. Deng Q, Wang E, Wu X, Cheng Q, Liu J, Li X. Combination of axitinib with dasatinib improves the outcome of a chronic myeloid leukemia patient with BCR-ABL1 T315I mutation. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2020;45(7):874–80. https://doi.org/10.11817/j.issn.1672-7347.2020.190116
7. Branford S, Melo JV, Hughes TP. Selecting optimal second-line tyrosine kinase inhibitor therapy for chronic myeloid leukemia patients after imatinib failure: Does the BCR-ABL mutation status really matter? Blood. 2009;114(27):5426–35. https://doi.org/10.1182/blood-2009-08-215939
8. Sun J, Wang X, Tang B, Cai Y, Liu J, Shao Z, et al. A tightly controlled Src-YAP signaling axis determines therapeutic response to dasatinib in renal cell carcinoma. Theranostics. 2018;8(12):3256–67. https://doi.org/10.7150/thno.23964
9. Lue HW, Derrick DS, Rao S, Van Gaest A, Cheng L, Podolak J, et al. Cabozantinib and dasatinib synergize to induce tumor regression in non-clear cell renal cell carcinoma. Cell Rep Med. 2021;2(5):100267. https://doi.org/10.1016/j.xcrm.2021.100267
10. Wang Z, Jiang L, Wang X, Yin H, Lv X, Wang Z, et al. Cabozantinib carries the risk of drug-drug interactions via inhibition of UDP-glucuronosyltransferase (UGT) 1A9. Curr Drug Metab. 2022;23(11):912–9. https://doi.org/10.2174/1389200224666221028140652
11. Motzer RJ, Escudier B, McDermott DF, George S, Hammers HJ, Srinivas S, et al. Nivolumab versus everolimus in advanced renal-cell carcinoma. N Engl J Med. 2015;373(19):1803–13. https://doi.org/10.1056/NEJMoa1510665
12. Choueiri TK, Powles T, Burotto M, Escudier B, Bourlon MT, Zurawski B, et al. Nivolumab plus cabozantinib versus sunitinib for advanced renal-cell carcinoma. N Engl J Med. 2021;384(9):829–41. https://doi.org/10.1056/NEJMoa2026982
13. Agrawal S, Feng Y, Roy A, Kollia G, Lestini B. Nivolumab dose selection: Challenges, opportunities, and lessons learned for cancer immunotherapy. J Immunother Cancer. 2016;4:72. https://doi.org/10.1186/s40425-016-0177-2
14. Dutcher JP, Wiernik PH. Renal cell carcinoma in patients with a personal or family history of hematologic malignancies. Clin Adv Hematol Oncol. 2015;13(6):392–7.
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Published
May 29, 2026
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How to Cite
Concurrent Chronic Myeloid Leukemia and Metastatic Renal Cell Carcinoma in a 61-year-old Female: Successful Treatment with Low-Dose Immunotherapy and Combination Targeted Therapy. (2026). Journal of Kidney Cancer, 13(2), 16-20. https://doi.org/10.15586/jkcvhl.v13i2.437
Section
Kidney Cancer: Case Reports
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How to Cite
Concurrent Chronic Myeloid Leukemia and Metastatic Renal Cell Carcinoma in a 61-year-old Female: Successful Treatment with Low-Dose Immunotherapy and Combination Targeted Therapy. (2026). Journal of Kidney Cancer, 13(2), 16-20. https://doi.org/10.15586/jkcvhl.v13i2.437