• Andrea Di Marco, Grazia Artioli, Adolfo Favaretto, Nicolò Cavasin, and Umberto Basso.
• Medical Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy.
• Medicine (Baltimore). 2024 Mar 29; 103 (13): e37606e37606.

RationaleTreatment with a combination of immune checkpoint inhibitors (ICIs) (pembrolizumab or nivolumab) and oral Tyrosine Kinase Inhibitors (TKI) targeting angiogenesis (axitinib, cabozantinib or lenvatinib) has shown benefits in terms of efficacy and survival in metastatic renal cell carcinoma (mRCC), with a favorable toxicity profile. However, some rare and serious treatment-related adverse events can be difficult to manage.Patient ConcernsHere we report the first case of an mRCC patient who, after only 2 administrations of pembrolizumab-axitinib, experienced severe multiorgan failure (MOF) with heart failure, oliguria and acute hepatitis requiring aggressive supportive treatment in intensive care unit.DiagnosesA diagnosis of severe MOF induced by pembrolizumab plus axitinib was considered.InterventionsThe patient was treated with dobutamine, levosimendan along with high-dose steroids under continuous cardiologic monitoring.OutcomesAfter treatment, the patient had a full recovery and was discharged from the hospital.LessonsWe reviewed all the other cases of MOF reported during treatment with combined ICI-TKI in cancer patients in order to summarize incidence, clinical manifestations and management with a specific focus on the need for prompt recognition and aggressive management under multidisciplinary care.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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