Supplementary Material for: Contemplation of the effect of nivolumab plus cabosantinib therapy on cerebral hemorrhage in patients with brain metastasis of renal cell carcinoma: A case report

Although the response to combination therapy has been reported in patients with brain metastases from advanced renal cancer, treatment-related cerebral hemorrhage has not been adequately studied. The CheckMate 9ER clinical trial of nivolumab and cabozantinib excluded patients with brain metastases. Therefore, the associated treatment outcomes in these patients with brain metastases are unclear. Herein, we report a case of bleeding from brain metastases in a patient with advanced renal cancer after gamma knife combination therapy with nivolumab and cabozantinib. Fortunately, the cerebral hemorrhage of the patient was alleviated by conservative treatment. Despite treatment interruption, the metastatic lesions reduced in size, and treatment was gradually resumed. In this case study, we report the risk of cerebral hemorrhage in combination therapy for brain metastasis cases, how to manage hemorrhage cases, and their prognosis.

尽管已有研究报道晚期肾癌脑转移患者对联合治疗的应答情况，但治疗相关性脑出血尚未得到充分探索。纳武利尤单抗（nivolumab）与卡博替尼（cabozantinib）的CheckMate 9ER临床试验未纳入脑转移患者，因此此类脑转移患者的相关治疗结局尚不明确。本文报告1例晚期肾癌患者在接受纳武利尤单抗、卡博替尼联合伽马刀（gamma knife）治疗后出现脑转移瘤出血的病例。所幸该患者的脑出血经保守治疗后得以缓解，尽管曾中断治疗，但转移灶体积缩小，后续逐步恢复了治疗方案。本病例研究旨在探讨脑转移瘤患者接受联合治疗时的脑出血风险、出血病例的管理策略及其预后情况。