Case Report: No radiographic evidence of disease for 45 months in a patient with recurrent clear cell renal cell carcinoma treated with third-line combination therapy utilizing toripalimab and axitinib.

Renal cancer is estimated to have accounted for 2.4% of all incident cancer cases worldwide in 2018. Renal cell carcinoma (RCC) is the most prevalent adult renal cancer, with the clear cell subtype accounting for 75-85% of cases and displaying pronounced genetic and biological heterogeneity. In the presence of metastatic disease, approximately 80% of patients are not expected to survive beyond one year. Immune checkpoint inhibitors targeting the programed death 1 (PD-1)/PD-L1 axis have been demonstrated to elicit durable clinical responses in patients with RCC. Subsequent therapeutic strategies for immunotherapy-naïve clear cell RCC, as recommended in the NCCN Guidelines Version 1.2026, include no preferred options; other recommended regimens encompass axitinib or lenvatinib in combination with pembrolizumab, cabozantinib with or without nivolumab, everolimus, lenvatinib, and nivolumab with or without ipilimumab. Currently, published evidence supporting the use of toripalimab in combination with axitinib as the third-line treatment for recurrent RCC remains limited. Thus, we report a case of recurrent clear cell RCC in which the patient achieved an overall survival of 14 years and sustained no radiographic evidence of disease for 45 months following third-line therapy with toripalimab in combination with axitinib. Based on the findings in this case, toripalimab combined with axitinib may be an option for relapsed clear cell RCC. Nevertheless, several limitations of this case report warrant acknowledgment: The diagnosis of recurrence was established based on imaging findings rather than confirmation via repeat biopsy and histopathological evaluation. As a case report, the level of evidence remains limited, and the reliability of the conclusions requires further validation in future studies.