IgG4相关性疾病(immunoglobulin-G4 related disease,IgG4-RD)是一种免疫介导的慢性纤维炎性疾病,可累及多个系统及器官。目前IgG4-RD合并恶性肿瘤且累及同一部位的病例鲜有报道。本文报道1例72岁男性患者,以肾脏肿瘤入院,结合镜检、免...IgG4相关性疾病(immunoglobulin-G4 related disease,IgG4-RD)是一种免疫介导的慢性纤维炎性疾病,可累及多个系统及器官。目前IgG4-RD合并恶性肿瘤且累及同一部位的病例鲜有报道。本文报道1例72岁男性患者,以肾脏肿瘤入院,结合镜检、免疫表型及血清学测定最终诊断为肾透明细胞肾细胞癌合并IgG4-RD。由于IgG4-RD缺少临床特异性,容易在诊治过程中被忽略,本例意在提示IgG4-RD与肿瘤同时存在的可能性,且两者之间的发生可能存在相关性,为诊断及研究提供新的思路,避免漏诊及误诊。展开更多
Background:While the treatment of metastatic renal cell carcinoma(mRCC)is evolving due to immune checkpoint inhibitors(ICIs),optimal strategies for later lines of therapy have yet to be defined.The combination of lenv...Background:While the treatment of metastatic renal cell carcinoma(mRCC)is evolving due to immune checkpoint inhibitors(ICIs),optimal strategies for later lines of therapy have yet to be defined.The combination of lenvatinib and everolimus represents a viable option,and the present review aimed to summarize its activity,effectiveness,and safety.Methods:A systematic review of the literature was conducted using PubMed,targeting studies published between 2018 and 2025.Eligible studies included English-language prospective and retrospective trials reporting survival outcomes in mRCC patients treated with lenvatinib and everolimus after at least one ICI-containing regimen.Results:Nine studies met the inclusion criteria,encompassing a total of 441 patients.The lenvatinib and everolimus combination was primarily used in the third and subsequent lines of therapy.Median overall survival ranged from 7.5 to 24.5 months,while median progression-free survival was more consistent,between 6.1 and 6.7 months,except for one study reporting 12.9 months.Objective response rates varied widely(14.0%–55.7%).Adverse events of grade≥3 did not exceed the expected rate,with diarrhoea and proteinuria as the most reported events.Dose reductions and treatment discontinuations due to toxicity occurred but were generally lower than in prior pivotal trials.Conclusions:Real-world evidence suggests that lenvatinib and everolimus represent an effective and safe option after ICI failure in mRCC patients.Nevertheless,the lack of randomized phase III trials and the heterogeneity of existing studies highlight the need for more robust prospective research to guide post-ICI therapeutic strategies.展开更多
文摘IgG4相关性疾病(immunoglobulin-G4 related disease,IgG4-RD)是一种免疫介导的慢性纤维炎性疾病,可累及多个系统及器官。目前IgG4-RD合并恶性肿瘤且累及同一部位的病例鲜有报道。本文报道1例72岁男性患者,以肾脏肿瘤入院,结合镜检、免疫表型及血清学测定最终诊断为肾透明细胞肾细胞癌合并IgG4-RD。由于IgG4-RD缺少临床特异性,容易在诊治过程中被忽略,本例意在提示IgG4-RD与肿瘤同时存在的可能性,且两者之间的发生可能存在相关性,为诊断及研究提供新的思路,避免漏诊及误诊。
文摘Background:While the treatment of metastatic renal cell carcinoma(mRCC)is evolving due to immune checkpoint inhibitors(ICIs),optimal strategies for later lines of therapy have yet to be defined.The combination of lenvatinib and everolimus represents a viable option,and the present review aimed to summarize its activity,effectiveness,and safety.Methods:A systematic review of the literature was conducted using PubMed,targeting studies published between 2018 and 2025.Eligible studies included English-language prospective and retrospective trials reporting survival outcomes in mRCC patients treated with lenvatinib and everolimus after at least one ICI-containing regimen.Results:Nine studies met the inclusion criteria,encompassing a total of 441 patients.The lenvatinib and everolimus combination was primarily used in the third and subsequent lines of therapy.Median overall survival ranged from 7.5 to 24.5 months,while median progression-free survival was more consistent,between 6.1 and 6.7 months,except for one study reporting 12.9 months.Objective response rates varied widely(14.0%–55.7%).Adverse events of grade≥3 did not exceed the expected rate,with diarrhoea and proteinuria as the most reported events.Dose reductions and treatment discontinuations due to toxicity occurred but were generally lower than in prior pivotal trials.Conclusions:Real-world evidence suggests that lenvatinib and everolimus represent an effective and safe option after ICI failure in mRCC patients.Nevertheless,the lack of randomized phase III trials and the heterogeneity of existing studies highlight the need for more robust prospective research to guide post-ICI therapeutic strategies.
