T-cell receptor repertoire analysis in a patient with metastatic renal cell carcinoma with sarcomatoid change successfully treated with nivolumab–ipilimumab combination therapy followed by deferred cytoreductive nephrectomy

Treatment of advanced renal cell carcinoma has improved with immune checkpoint inhibitors; however, the role of deferred cytoreductive nephrectomy and biomarkers for immune-related adverse events remains unclear. We report a man in his seventies with metastatic renal cell carcinoma with sarcomatoid change treated with nivolumab plus ipilimumab followed by deferred cytoreductive nephrectomy. Despite grade 3 adrenal insufficiency, a durable complete response was maintained with nivolumab monotherapy. T-cell receptor repertoire analysis revealed decreased diversity and increased clonality after treatment, suggesting its potential as a biomarker of therapeutic response and immune-related toxicity.