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REVIEW

Immunotherapy in Bellini Duct Carcinoma: A Systematic Review

Antonio David Lázaro-Sánchez1,2,*, Javier David Benítez-Fuentes3, Sofía Wikström-Fernández4, María Nevado-Rodríguez5, Pablo Conesa-Zamora2,6, Ginés Luengo-Gil2,6, Alejandra Ivars-Rubio5, Marta Zafra-Poves5, Edgardo D. Carosella7, Belén Fernández-Molina8, Andrés Nieto-Olivares9, María José Sánchez de las Matas Garre10, Ana Belén Arroyo2,6
1 Department of Medical Oncology, University Clinical Hospital Virgen de la Arrixaca, Murcia, Spain
2 Group of Molecular Pathology and Pharmacogenetics, Biomedical Research Institute from Murcia (IMIB), Laboratory Medicine and Pathology Department, Santa Lucía General University Hospital, Cartagena, Spain
3 Department of Medical Oncology, Elche General University Hospital, Alicante, Spain
4 Department of Medical Oncology, Santa Lucia General University Hospital, Cartagena, Spain
5 Department of Medical Oncology, Morales Meseguer General University Hospital, Murcia, Spain
6 Health Sciences Faculty, Universidad Católica de Murcia (UCAM), Guadalupe, Spain
7 CEA, DRF-Institut de Biologie François Jacob, Service de Recherches en Hémato-Immunologie, Hôpital Saint-Louis, Paris, France
8 Family and Community Medicine, Lorenzo Guirao Hospital, Murcia, Spain
9 Department of Pathological Anatomy, Morales Meseguer General University Hospital, Murcia, Spain
10 Department of Pathological Anatomy, Santa Lucía General University Hospital, Cartagena, Spain
* Corresponding Author: Antonio David Lázaro-Sánchez. Email: email
(This article belongs to the Special Issue: Advances in Cancer Immunotherapy)

Oncology Research https://doi.org/10.32604/or.2026.081674

Received 06 March 2026; Accepted 27 May 2026; Published online 12 June 2026

Abstract

Background: Collecting duct carcinoma (CDC; Bellini duct carcinoma) is a rare, aggressive renal cancer with no established standard of care, and evidence for immune checkpoint inhibitor (ICI)-based therapy in CDC remains emerging and fragmented. We aimed to systematically synthesise efficacy and safety data on immunotherapy in adult patients with CDC. Methods: PubMed and Web of Science were searched from inception to 29 March 2025, with targeted post-search monitoring of key journals and ClinicalTrials.gov updated on 11 April 2026. Prospective interventional studies, observational cohorts/registries, and case series/reports were eligible. Screening, extraction and risk-of-bias appraisal (Joanna Briggs Institute tools) were performed independently in duplicate; results were narratively synthesised. Results: Overall, ICIs—particularly combinations—showed clinically meaningful activity in a subset of CDC patients. Twenty-four studies met criteria (2 prospective trials, 8 observational cohorts, 14 case-level publications/16 patients). The SUNNIFORECAST randomised phase II trial reported a CDC-specific ORR of 40% with ipilimumab + nivolumab versus 20% with standard of care (n = 9 CDC). Observational evidence yielded ORR ~10–44% and mOS ~13–42 months depending on regimen, with the highest activity seen with ICI plus TKI combinations. Durable complete responses (≥3–6 years) were documented at case level with dual checkpoint blockade and anti-PD-1 monotherapy. Safety was generally manageable, though serious events occurred sporadically (immune-mediated hepatitis; one fatal pneumonia). Conclusions: ICIs—particularly combination strategies—demonstrate clinically meaningful activity in selected patients with CDC, but evidence is limited by small samples, heterogeneity and high risk of bias. Prospective, biomarker-informed CDC-dedicated trials and coordinated registries are needed.

Keywords

Collecting duct carcinoma; Bellini duct carcinoma; immunotherapy; PD-1/PD-L1 blockade; systematic review

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