The case of a patient with metastatic
renal cell carcinoma who exhibited the abscopal effect following treatment by anti-programmed death-1 (PD-1) antibody is presented. A 40-year-old woman was diagnosed with an 8.2-cm renal
tumor without distant
metastases, and radical
nephrectomy was subsequently performed. Pathological examination revealed a
clear cell renal cell carcinoma. At 3 months after surgery, the patient developed one lung
metastasis. Following treatment with
interferon and three types of
tyrosine kinase inhibitors, anti-PD1 antibody (
nivolumab) was started. During the treatment, para-aortic/supraclavicular lymph nodes and several lung lesions remained, although other lesions decreased markedly. The patient was subsequently treated by palliative
radiotherapy to the para-aortic and supraclavicular lymph nodes for
pain control. After the
radiotherapy, the lung lesions previously refractory to
nivolumab started to decrease, probably due to an abscopal effect. Additionally, the laboratory data and Karnofsky Performance Status improved. Histological re-examination of the primary lesion revealed heterogeneity of the immunological microenvironment, which may be associated with the heterogeneity of treatment sensitivity.