Dual Pathway Inhibition in Patients With mRCC: A Case Series From Kuwait Highlighting the Role of Avelumab and Axitinib

Background Renal cell carcinoma (RCC) accounts for approximately 3% of adult cancers and is characterized by aggressive behavior and early metastatic potential. The therapeutic paradigm of metastatic RCC (mRCC) has evolved from tyrosine kinase inhibitors (TKIs) alone to immune checkpoint inhibitors (ICIs) and ICI–TKI combinations. Avelumab, an anti–PD‐L1 antibody, in combination with axitinib, a VEGFR‐targeted TKI, has demonstrated efficacy in pivotal trials such as JAVELIN Renal 101. Objective The objective of this study is to report the clinical outcomes of four patients with advanced mRCC and extensive metastases treated with avelumab with axitinib at the Kuwait Cancer Control Center (KCCC). Methods This case series describes diagnostic imaging, treatment regimens, and disease progression in four patients. Imaging modalities included PET‐CT and CT scans, performed at multiple intervals to assess therapeutic response, disease control, and treatment tolerability. Results All patients demonstrated favorable radiological and clinical responses despite high metastatic burden and the presence of comorbidities, including disease regression or stable disease across multiple metastatic sites. Treatment was generally well tolerated, with no Grade III or IV toxicities recorded. Conclusion This case series involving patients treated at KCCC demonstrates the real‐world efficacy and tolerability of avelumab plus axitinib as a first‐line option for metastatic renal cell carcinoma, even in patients with high metastatic burden, comorbidities, or prior treatment failure. Outcomes observed are consistent with JAVELIN Renal 101 trial findings, reinforcing the therapeutic value of dual immune and angiogenic pathway inhibition in advanced RCC care. Further investigation into biomarkers and patient selection may help optimize clinical outcomes across diverse populations.