Spontaneous Regression Of Metastatic Renal Cell Carcinoma After Sars-cov-2 Infection: A Report Of Two Cases
Buchler, T., Fiser, L., Benesova, J., Jirickova, H., & Votrubova, J. (2021). Spontaneous Regression of Metastatic Renal Cell Carcinoma after SARS-CoV-2 Infection: A Report of Two Cases. Current oncology (Toronto, Ont.), 28(5), 3403–3407. https://doi.org/10.3390/curroncol28050294
View Original Source →Abstract
Spontaneous regression of metastatic renal cell carcinoma (mRCC) is a rare event, often associated with an activation of innate immunity by various triggers. SARS-CoV-2 infection induces a strong inflammatory response in some patients and a cytokine storm is one of the main causes of severe morbidity and mortality associated with the virus. Here, we describe two cases of patients with histologically and radiologically proven mRCC whose treatment was delayed due to COVID-19 and who experienced spontaneous tumour regression following the infection. Both patients reported here had predominantly pulmonary and mediastinal involvement and underwent nephrectomy. The interval between the diagnosis of COVID-19 and the detection of tumour regression was 3 and 4 months, respectively. Although approved vaccines and other measures are clearly the best way to prevent COVID-19-associated morbidity and mortality in cancer patients, we hypothesize that innate immunity activation by the infection can contribute to tumour regression in special circumstances.
Case Details
Disease Location
Kidney
Personal Characteristics
58-year-old male
Clinical Characteristics
Presented with fever and headache. A pcr test for sars-cov-2 was positive, and the patient was started on antibiotics; firstly, clarithromycin and, subsequently, amoxicillin clavulanate for persistent fever. A chest x-ray showed bilateral lung infiltrates. Therapy with prednisone was initiated. 1 month after the first presentation, repeat x-ray revealed multiple bilateral round dense opacities. The patient was still subfebrile and had lost 10 kg over the previous 8 weeks. A CT scan showed post-covid-19 lung parenchymal changes, and also a left renal mass and multiple lung lesions consistent with metastatic cancer. 2 months later, an uncomplicated left nephrectomy was carried out, with histology reported as poorly differentiated clear cell carcinoma with sarcomatoid features. At his first oncology appointment, 6 months after initial admission, blood tests showed renal insufficiency, anaemia, mildly increased c-reactive protein, and increased platelet count
Remission Characteristics
PET/CT showed a marked reduction in lung metastases
Treatment & Mechanisms
Proposed Remission Mechanisms
Strong innate sars-cov-2-induced immune response. Antimicrobial treatment contributed to the tumour regression.
Clinical Treatment
Clarithromycin, amoxicillin clavulanate, prednisone, nephrectomy