---
title: "Benmelstobart plus anlotinib for advanced clear cell RCC: case of prolonged survival and managemen"
id: "pubmed-42493457"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42493457"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42493457/"
doi: "10.19723/j.issn.1671-167X.2026.04.026"
published_at: "2026-08-18T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Benmelstobart plus anlotinib for advanced clear cell RCC: case of prolonged survival and managemen
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42493457
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42493457/)
- **DOI:** [10.19723/j.issn.1671-167X.2026.04.026](https://doi.org/10.19723%2Fj.issn.1671-167X.2026.04.026)
- **Published At:** 2026-08-18T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Case report of a 65-year-old man with advanced **clear cell renal cell carcinoma (ccRCC)** who developed multiple metastases (lungs, liver, bone) shortly after radical nephrectomy. Laboratory features included anemia, neutrophilia, and thrombocytosis; IMDC score was 5 (poor risk). - First-line systemic therapy combined the PD-L1 inhibitor **benmelstobart** with the multi-target TKI **anlotinib**. Radiologic partial response (PR) was documented at 6 weeks with about **48% tumor reduction**. - Durable PR was maintained on subsequent imaging, with clinical symptom improvement and better performance status during combination treatment. - The patient developed progressive proteinuria during therapy, with a maximum 24-hour urinary protein of **5.18 g**. Anlotinib dose reductions were attempted but proteinuria recurred, prompting discontinuation of the TKI. - After stopping anlotinib, the patient continued **benmelstobart** as maintenance monotherapy and sustained deep remission for an extended period. - After roughly 3 years of treatment, serum creatinine rose progressively to a peak of **228 μmol/L**. Considering possible treatment-related renal toxicity and stable disease, immunotherapy was discontinued and no further antitumor therapy was given. - The patient later experienced disease progression and died in September 2024, with an overall survival of **44 months**. - Authors propose that combined anti-angiogenic therapy plus immunotherapy can induce rapid and durable responses in IMDC poor-risk ccRCC, and that TKI discontinuation for intolerable adverse events followed by maintenance immunotherapy may still deliver long-term disease control. - The report emphasizes vigilance for **renal toxicity** during combined targeted and immune therapy and the need for individualized treatment adjustment. The mechanism for sustained benefit may relate to tumor microenvironment remodeling and immunological memory induced by anti-angiogenic therapy.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute; Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China. * 2 Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing 100191, China. * PMID: **42493457** * PMCID: **PMC13402080** (available on 2026-08-18) * DOI: [ 10.19723/j.issn.1671-167X.2026.04.026 ](https://doi.org/10.19723/j.issn.1671-167x.2026.04.026) Item in Clipboard Case Reports # [Long-term survival achieved with benmelstobart plus anlotinib in a patient with advanced clear cell renal cell carcinoma: A case report] [Article in Chinese] Huichun Tian et al. Beijing Da Xue Xue Bao Yi Xue Ban. 2026. Show details Display options Display options Format Abstract PubMed PMID Beijing Da Xue Xue Bao Yi Xue Ban Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Beijing+Da+Xue+Xue+Bao+Yi+Xue+Ban%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Beijing+Da+Xue+Xue+Bao+Yi+Xue+Ban%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42493457/) . 2026 Aug 18;58(4):865-871. doi: 10.19723/j.issn.1671-167X.2026.04.026. ### Authors [Huichun Tian](https://pubmed.ncbi.nlm.nih.gov/?term=Tian+H&cauthor_id=42493457)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42493457/#short-view-affiliation-1 "Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute; Key Laboratory of Carcinogenesis and Translational Research \(Ministry of Education\), Beijing 100142, China."), [Jiaran Zhang](https://pubmed.ncbi.nlm.nih.gov/?term=Zhang+J&cauthor_id=42493457)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42493457/#short-view-affiliation-2 "Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing 100191, China."), [Juan Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+J&cauthor_id=42493457)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42493457/#short-view-affiliation-1 "Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute; Key Laboratory of Carcinogenesis and Translational Research \(Ministry of Education\), Beijing 100142, China.") ### Affiliations * 1 Department of Genitourinary Oncology, Peking University Cancer Hospital & Institute; Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China. * 2 Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing 100191, China. * PMID: **42493457** * PMCID: **PMC13402080** (available on 2026-08-18) * DOI: [ 10.19723/j.issn.1671-167X.2026.04.026 ](https://doi.org/10.19723/j.issn.1671-167x.2026.04.026) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract in [ English, ](https://pubmed.ncbi.nlm.nih.gov/42493457/#eng-abstract) [ Chinese ](https://pubmed.ncbi.nlm.nih.gov/42493457/#zho-abstract) Clear cell renal cell carcinoma (ccRCC) is the most common histological subtype of renal cell carcinoma. Patients classified as intermediate- or poor-risk according to the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC), particularly those with multiple organ metastases, generally have an unfavorable prognosis. Here, we report a case of advanced ccRCC in an IMDC poor-risk patient who achieved an unexpectedly prolonged survival with combination therapy followed by maintenance immunotherapy. A 65-year-old male developed multiple metastases involving the lungs, liver, and bone shortly after undergoing radical nephrectomy for right-sided renal cancer. Laboratory findings revealed anemia, neutrophilia, and thrombocytosis, and the IMDC score was 5, indicating poor-risk disease. The patient received first-line treatment with the programmed death-ligand 1 (PD-L1) inhibitor benmelstobart in combination with the multi-target tyrosine kinase inhibitors (TKIs) anlotinib. After 6 weeks of therapy, radiological evaluation demonstrated a partial response (PR), with an overall tumor reduction of approximately 48%. Subsequent imaging assessments confirmed a durable PR, accompanied by significant improvement in clinical symptoms and performance status. During treatment, the patient developed progressive proteinuria, with a maximum 24-hour urinary protein level of 5.18 g. Despite stepwise dose reduction of anlotinib, proteinuria recurred, necessitating discontinuation of the TKIs. Following cessation of anlotinib, the patient continued benmelstobart monotherapy as maintenance therapy and maintained sustained deep remission. After approximately 3 years of treatment, serum creatinine levels gradually increased, reaching a peak of 228 μmol/L. Considering the possibility of treatment-related renal toxicity and the durable disease control achieved, immunotherapy was subsequently discontinued. No further antitumor treatment was administered. The patient eventually experienced disease progression and died in September 2024, with an overall survival of 44 months. This case suggests that the combination of benmelstobart and anlotinib can induce rapid and durable antitumor responses in patients with IMDC poor-risk advanced ccRCC. Notably, in patients who respond well to combination therapy, discontinuation of TKIs due to intolerable adverse events followed by maintenance immunotherapy may still provide long-term disease control. This sustained benefit may be associated with tumor microenvironment remodeling and the establishment of immunological memory induced by anti-angiogenic therapy. Furthermore, this case highlights the importance of vigilant monitoring of renal toxicity and individualized treatment adjustment during combined targeted therapy and immunotherapy. 透明细胞肾细胞癌(clear cell renal cell carcinoma，ccRCC)是肾细胞癌最常见的病理类型，国际转移性肾癌数据库联盟(International Metastatic Renal Cell Carcinoma Database Consortium，IMDC)中高危患者，尤其伴多器官转移者预后较差。本文报道1例IMDC高危晚期ccRCC患者，男性，65岁，行右肾癌根治术后短期内出现肺、肝及骨多发转移，伴贫血、中性粒细胞及血小板升高，IMDC评分5分。患者接受贝莫苏拜单抗联合安罗替尼一线治疗，治疗6周后影像学评估即达到部分缓解(partial response，PR)，后续多次复查持续维持PR，肿瘤总体缩小约48%，临床症状明显改善。治疗过程中患者出现进行性蛋白尿，经安罗替尼逐步减量后仍反复出现，最终停用靶向治疗后蛋白尿明显缓解。停用安罗替尼后患者继续接受贝莫苏拜单抗单药维持治疗，疾病持续维持深度缓解。治疗约3年后患者出现血肌酐升高，最高达228 μmol/L，综合考虑肾损伤及疾病稳定状态后停用免疫治疗。此后未再接受抗肿瘤治疗，直至2024年9月疾病进展并死亡，总生存期达44个月。本病例提示，在IMDC高危晚期ccRCC患者中，贝莫苏拜单抗联合安罗替尼可实现快速且持久的抗肿瘤效应，对联合治疗敏感的患者，在发生不可耐受不良反应时停用酪氨酸激酶抑制剂(tyrosine kinase inhibitors，TKIs)，并转为免疫单药维持治疗，仍可能获得长期疾病控制，其机制可能与抗血管生成治疗诱导的肿瘤免疫微环境重塑及免疫记忆效应有关。本病例同时提示，在靶向联合免疫治疗过程中应重视肾毒性监测，并进行个体化治疗调整。 **Keywords:** Clear cell renal cell carcinoma; Immunotherapy; Targeted therapy. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement 利益冲突 所有作者均声明不存在利益冲突。 ## Similar articles * [ Benmelstobart plus anlotinib versus pembrolizumab as first-line treatment for PD-L1-positive, advanced non-small-cell lung cancer (CAMPASS): a blinded, randomised, controlled, phase 3 trial. ](https://pubmed.ncbi.nlm.nih.gov/41825453/) Zhong H, Wang J, Yang R, Luo Y, Zuo W, Zhang W, Xie C, Li Q, Liu Q, Xu X, Wang Q, Yu Y, Chen Y, Yi T, Min X, Shi J, Yang J, Sun H, Chen H, Shi H, Gao J, Shi J, Zhang B, Chu T, Li K, Han B; CAMPASS Investigators.Zhong H, et al.Lancet Oncol. 2026 Apr;27(4):419-431. doi: 10.1016/S1470-2045(26)00049-5. Epub 2026 Mar 10.Lancet Oncol. 2026.PMID: 41825453Clinical Trial. * [ Case report: Sintilimab combined with anlotinib as neoadjuvant chemotherapy for metastatic bone tumor resection in patients with PSC. ](https://pubmed.ncbi.nlm.nih.gov/38756778/) Bao Z, Yu X, Zheng K, Zhai K, Cui H, Xu M.Bao Z, et al.Front Immunol. 2024 May 2;15:1372279. doi: 10.3389/fimmu.2024.1372279. eCollection 2024.Front Immunol. 2024.PMID: 38756778Free PMC article. * [ A 73-Year-Old Man With a Late Isolated Brain Metastasis of Clear Cell Renal Cell Carcinoma Following a Durable Complete Response to Lenvatinib-Pembrolizumab, Resulting in Deferred Cytoreductive Nephrectomy. ](https://pubmed.ncbi.nlm.nih.gov/42452828/) Ito F, Kobayashi K, Hayashi G, Kamijo S, Fujita T.Ito F, et al.Am J Case Rep. 2026 Jul 15;27:e953192. doi: 10.12659/AJCR.953192.Am J Case Rep. 2026.PMID: 42452828Free PMC article. * [ First-Line Treatment Strategies in IMDC Favourable-Risk Metastatic Clear Cell Renal Cell Carcinoma. ](https://pubmed.ncbi.nlm.nih.gov/42500582/) Valdés A, González-Montero J, Rojas C, Burotto M.Valdés A, et al.Oncol Res. 2026 Jul 16;34(8):4. doi: 10.32604/or.2026.077711. eCollection 2026.Oncol Res. 2026.PMID: 42500582Free PMC article.Review. * [ Sequencing and Combination of Systemic Therapy in Metastatic Renal Cell Carcinoma. ](https://pubmed.ncbi.nlm.nih.gov/31377308/) de Velasco G, Bex A, Albiges L, Powles T, Rini BI, Motzer RJ, Heng DYC, Escudier B.de Velasco G, et al.Eur Urol Oncol. 2019 Sep;2(5):505-514. doi: 10.1016/j.euo.2019.06.022. Epub 2019 Aug 1.Eur Urol Oncol. 2019.PMID: 31377308Review. [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42493457) ## References 1. 1. Larcher A, Campi R, Bex A, et al. Epidemiology of renal cancer: Incidence, mortality, survival, genetic predisposition, and risk factors. Eur Urol. 2025;88(4):341–358. doi: 10.1016/j.eururo.2025.06.005. - [DOI](https://doi.org/10.1016/j.eururo.2025.06.005) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/40750496/) 2. 1. Rose TL, Kim WY. Renal cell carcinoma: A review. JAMA. 2024;332(12):1001. doi: 10.1001/jama.2024.12848. - [DOI](https://doi.org/10.1001/jama.2024.12848) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC11790279/) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/39196544/) 3. 1. Barragan-Carrillo R, Saad E, Saliby RM, et al. First and second-line treatments in metastatic renal cell carcinoma. Eur Urol. 2025;87(2):143–154. doi: 10.1016/j.eururo.2024.10.019. - [DOI](https://doi.org/10.1016/j.eururo.2024.10.019) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/39505582/) 4. 1. Rini BI, Plimack ER, Stus V, et al. Pembrolizumab plus axitinib versus sunitinib for advanced clear cell renal cell carcinoma: 5-year survival and biomarker analyses of the phase 3 KEYNOTE-426 trial. Nat Med. 2025;31(10):3475–3484. doi: 10.1038/s41591-025-03867-5. - [DOI](https://doi.org/10.1038/s41591-025-03867-5) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC12532709/) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/40750932/) 5. 1. Motzer RJ, Escudier B, Burotto M, et al. Final analysis of nivolumab plus cabozantinib for advanced renal cell carcinoma from the randomized phase Ⅲ CheckMate 9ER trial. Ann Oncol. 2026;37(1):33–43. doi: 10.1016/j.annonc.2025.09.006. - [DOI](https://doi.org/10.1016/j.annonc.2025.09.006) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC12522107/) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/40998092/) Show all 21 references ## Publication types * Case Reports Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Case+Reports%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Case+Reports) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42493457/) * English Abstract Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22English+Abstract%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=English+Abstract) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42493457/) ## MeSH terms * Aged Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Aged%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Aged) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42493457/) * Antineoplastic Combined Chemotherapy Protocols* / therapeutic use Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih
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