Complete response in metastatic clear cell renal cell carcinoma following pembrolizumab–axitinib and subsequent nephrectomy: a Case Report

BackgroundRenal cell carcinoma (RCC) is the most common kidney cancer in adults. The advent of immune checkpoint inhibitors (ICIs), particularly in combination with tyrosine kinase inhibitors (TKIs), has significantly improved outcomes in advanced disease.Case presentationA 67-year-old woman with stage IV clear cell RCC and intermediate-risk features presented with pulmonary, nodal, and peritoneal metastases. She received first-line pembrolizumab plus axitinib, achieving durable disease control and partial response with good tolerability. After 32 months she achieved sustained disease stability and underwent robot-assisted left nephrectomy. Histology revealed complete pathological response. Postoperatively, pembrolizumab was continued with a pseudo-adjuvant intent, and as of March 2026, the patient remains in radiological near-complete response with a progression-free survival of approximately 41 months from treatment initiation.Discussion and conclusionsThis case illustrates that ICI–TKI combinations can induce profound and durable responses even in intermediate-risk metastatic RCC. Consolidative surgery after systemic control, though still under debate, may be beneficial for carefully selected patients. Overall, this report underscores the potential of immunotherapy–TKI combinations to achieve long-term remission and the importance of a multidisciplinary, personalized treatment approach in advanced RCC.