Management of Metastatic Clear Cell Renal Cell Carcinoma
Guideline Status: Current
Published Online: September 11, 2023
Last Updated: October 18, 2023
Rapid Recommendation Update
Published online September 11, 2023
Updated Recommendation 3.6. Treatment with ipilimumab, nivolumab, cabozantinib (IpiNivoCabo) is not recommended for patients with metastatic renal clear cell cancer (ccRCC). Patients interested in triplet therapy should enroll in a clinical trial. (Type: Evidence-based; harms outweigh the benefits [harms of IpiNivoCabo outweigh the benefits]; Evidence quality: High; Strength of recommendation: Strong).
This rapid recommendation provides timely guidance on IpiNivoCabo.
2022 Guideline Abstract
Published online before print: June 21, 2022. DOI: 10.1200/JCO.22.00868
W. Kimryn Rathmell, R. Bryan Rumble, Peter J. Van Veldhuizen, Hikmat Al-Ahmadie, Hamid Emamekhoo, Ralph J. Hauke, Alexander V. Louie, Matthew I. Milowsky, Ana M. Molina, Tracy L. Rose, Shankar Siva, Nicholas G. Zaorsky, Tian Zhang, Rubina Qamar, Terry M. Kungel, Bryan Lewis, and Eric A. Singer.
Purpose
To provide recommendations for the management of patients with metastatic clear cell renal cell carcinoma (ccRCC).
Methods
An Expert Panel conducted a systematic literature review to obtain evidence to guide treatment recommendations.
Results
The panel considered peer-reviewed reports published in English.
Recommendations
The diagnosis of metastatic ccRCC should be made using tissue biopsy of the primary tumor or a metastatic site with the inclusion of markers and/or stains to support the diagnosis. The International Metastatic RCC Database Consortium risk criteria should be used to inform treatment. Cytoreductive nephrectomy may be offered to select patients with kidney-in-place and favorable- or intermediate-risk disease. For those who have already had a nephrectomy, an initial period of active surveillance may be offered if they are asymptomatic with a low burden of disease. Patients with favorable-risk disease who need systemic therapy may be offered an immune checkpoint inhibitor (ICI) in combination with a vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor (TKI); patients with intermediate or poor risk should be offered a doublet regimen (no recommendation was provided between ICIs or an ICI in combination with a VEGFR TKI). For select patients, monotherapy with either an ICI or a VEGFR TKI may be offered on the basis of comorbidities. Interleukin-2 remains an option, although selection criteria could not be identified. Recommendations are also provided for second- and subsequent-line therapy as well as the treatment of bone metastases, brain metastases, or the presence of sarcomatoid features. Participation in clinical trials is highly encouraged for patients with metastatic ccRCC.
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