Avelumab plus Axitinib for the Treatment of Patients with End-Stage Renal Disease Undergoing Dialysis: A Retrospective Case Series and Literature Review

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Figure legend:

Figure 1. Computed tomography (CT) images before (A, C, E, G, I) and after(B, D, F, H, J) systemic

therapy with avelumab plus axitinib.

(A, B) Paraaortic lymph node metastasis before (A) and six months after (B) systemic therapy with

avelumab plus axitinib in case 1.

(C-F) Primary lesion of right kidney and subpleural metastasis before (C, E) and two months after

(D,F) systemic therapy with avelumab plus axitinib in case 2.

(G-J) lung metastasis and subdiaphragmatic metastasis before (G, I) and three months after (H,J)

systemic therapy with avelumab plus axitinib in case 3.

Table 1. Summary of the combination therapies, including immune checkpoint inhibitors, used in

prior case reports and for the present patients

Reference

Number

of

Patients

Histology

IMDC Risk

Classification

Site of

Metastasis

Type of

Therapy

Adverse Events

Best

Response

Clear cell RCC

Intermediate

Ipi + Nivo

None

Clear cell RCC

Intermediate

Pem + Axi

None/hypertensi

on

Stable

disease

N/A

Iwaki et al.

[6]

Shaw et al.

[7]

N/A

Intermediate

Retroperit

oneum

Lung,

bone,

ipsilateral

kidney

Lung

Ipi + Nivo

None

Intermediate

Lymph

node

Ipi + Nivo

Pneumonitis

Present

cases

Clear cell RCC

with sarcomatoid

change

Papillary RCC,

type II

Intermediate

Lymph

node

Ave + Axi

Partial

response

Acquired cystic

diseaseassociated RCC

Poor

Ave + Axi

Clear cell RCC

Intermediate

Lymph

node, liver,

lung,

pleura

Diaphragm

, lung

Hand-foot

syndrome (G1),

pruritus (G1),

adrenal

insufficiency (G2)

None

Fever (G2),

hypothyroidism

(G1), appetite loss

(G1), general

fatigue (G1)

Partial

response

Kobayashi

et al. [4]

Katsumata

et al. [5]

Ave + Axi

G, grade; RCC, renal cell carcinoma; IMDC, International Metastatic RCC Database Consortium; N/A,

not applicable; Ipi, ipilimumab; Nivo, nivolumab; Pem, pembrolizumab; Axi, axinitib; Ave, avelumab.

Stable

disease

Partial

response

Partial

response

...