W Kimryn Rathmell1, R Bryan Rumble2, Peter J Van Veldhuizen3, Hikmat Al-Ahmadie4, Hamid Emamekhoo5, Ralph J Hauke6, Alexander V Louie7,8, Matthew I Milowsky9, Ana M Molina10, Tracy L Rose9, Shankar Siva11, Nicholas G Zaorsky8,12, Tian Zhang13, Rubina Qamar14, Terry M Kungel15, Bryan Lewis16,17, Eric A Singer18. 1. Vanderbilt University Medical Center, Nashville, TN. 2. American Society of Clinical Oncology, Alexandria, VA. 3. University of Rochester Medical Center, Rochester, NY. 4. Memorial Sloan Kettering Cancer Center, New York, NY. 5. University of Wisconsin Carbone Cancer Center, Madison, WI. 6. Nebraska Cancer Specialists, Omaha, NE. 7. Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON. 8. American Society for Therapeutic Radiology and Oncology Representative, Fairfax, VA. 9. University of North Carolina at Chapel Hill, Chapel Hill, NC. 10. Weill Cornell Medicine, New York, NY. 11. Peter MacCallum Cancer Centre, Melbourne, Australia. 12. Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve School of Medicine, Cleveland, OH. 13. Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX. 14. Advocate Aurora Health, Milwaukee, WI. 15. Patient Representative, Woolwich, ME. 16. KidneyCan, Philadelphia, PA. 17. Patient Representative, Philadelphia, PA. 18. Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
Abstract
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.Additional information is available at www.asco.org/genitourinary-cancer-guidelines.
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.Additional information is available at www.asco.org/genitourinary-cancer-guidelines.