Onkologie. 2025:19(4):246-249 | DOI: 10.36290/xon.2025.046

Toxicity of combined immunotherapy with ipilimumab and nivolumab in advanced renal cell carcinoma

Michaela Tkadlecová, Luboš Mastný

Onkologická a radioterapeutická klinika Fakultní nemocnice Plzeň

Systemic Antitumor Immunotherapy (IT) is now the cornerstone of systemic treatment for advanced renal carcinoma. Despite the significant benefits of this therapy, its associated toxicity must not be overlooked. This case report discusses a 51-year-old patient with generalized clear cell renal carcinoma. The patient was indicated for immunotherapy in combination with a monoclonal antibody against the CTLA-4 antigen (ipilimumab at a dose of 1 mg/kg) and an antibody against the programmed cell death receptor PD-1 (nivolumab 3 mg/kg).Initially, the treatment was well tolerated, but after four cycles of the mentioned combination, the patient developed grade 3-4 gastrointestinal toxicity - diarrheal disease with a frequency of 10-15 stools per day. Following recommended guidelines, immunotherapy was discontinued, and corticosteroid (CS) treatment was initiated, leading to a partial resolution of symptoms. The patient was subsequently indicated for colonoscopy with biopsy sampling, and upon confirmation of autoimmune colitis, infliximab administration was considered. However, the findings were complicated by concurrent cytomegalovirus (CMV) colitis, making infliximab administration impossible. Repeated attempts to taper CS doses resulted in recurrent colitis, further complicated by Clostridium difficile colitis. After prolonged corticosteroid therapy, symptoms partially subsided. Control colonoscopy revealed colonic mucosa with preserved architecture and mixed inflammatory infiltration of the lamina propria. This condition allowed the resumption of oncological treatment, this time with the VEGFR tyrosine kinase inhibitor pazopanib, which the patient tolerates without complications. According to restaging examinations, partial regression of the findings persists.

Keywords: renal carcinoma, immunotherapy toxicity, nivolumab, ipilimumab, autoimmune colitis.

Accepted: September 30, 2025; Published: October 8, 2025  Show citation