Kidney Cancer, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology
- Study type
- Clinical guideline
- Study name
- NCCN Kidney Cancer v3.2022
- Design
- Clinical guideline based on evidence and panel consensus (NCCN categories of evidence and consensus, and categories of preference)
- Source
- J Natl Compr Canc Netw · 2022
In plain words
NCCN is a network of major cancer centres in the USA that publishes treatment guidelines for each cancer. In this version, for advanced clear cell kidney cancer, immunotherapy combinations (alone or with drugs that block blood vessel growth) are named as the preferred first treatments, and for some patients without symptoms and with low-risk disease, close monitoring without starting medicine straight away is also an acceptable option.
Key guideline recommendations
- Category 1, preferred
Axitinib + pembrolizumab first line for ccRCC patients in all risk groups.
- Category 1, preferred
Cabozantinib + nivolumab first line for ccRCC patients in all risk groups.
- Category 1, preferred
Lenvatinib + pembrolizumab first line for ccRCC patients in all risk groups (lenvatinib + everolimus was not added to the guideline as a first-line option).
- Category 1, preferred
Ipilimumab + nivolumab first line for ccRCC patients with poor and intermediate risk.
- Category 2A, other recommended regimens
Ipilimumab + nivolumab first line for ccRCC patients with favourable risk (FDA approval for this combination is limited to intermediate and poor risk).
- Category 2A, preferred
Single-agent cabozantinib first line for ccRCC patients with poor and intermediate risk.
- Category 2A, useful in certain circumstances
Active surveillance for selected asymptomatic patients with favourable-risk advanced ccRCC.
- Panel recommendation (no numerical category in the text)
Cytoreductive nephrectomy before systemic therapy is recommended in selected patients with a potentially resectable primary tumour; patients with haematuria or other symptoms from the primary tumour should undergo palliative nephrectomy if they are surgical candidates.
- Category 1, preferred
In subsequent-line treatment of ccRCC: cabozantinib, lenvatinib + everolimus and nivolumab are preferred options.
Study population
Patients with relapsed or stage IV renal cell carcinoma; this paper summarises recommendations on surgery and systemic therapy by histology (clear cell and non-clear cell) and risk group.
Endpoints
Regimens are classified by NCCN category of evidence/consensus (1, 2A, 2B, 3) and category of preference (“preferred”, “other recommended regimens”, “useful in certain circumstances”).
Clinical significance and place in guidelines
The NCCN guideline is a widely used reference in the USA and many other countries, and its “preferred/other/useful in certain circumstances” classification helps with regimen choice. This paper also gives the FDA approval dates for the first-line combinations (ipilimumab/nivolumab April 2018; axitinib/pembrolizumab April 2019; cabozantinib/nivolumab January 2021; lenvatinib/pembrolizumab August 2021). The NCCN guideline is updated several times a year, and newer versions (such as version 2.2024) include more recent data; for clinical decisions see the current version at NCCN.org.
Limitations
This paper covers only the relapsed/stage IV disease section; it dates from 2022 and was written before the KEYNOTE-564 overall survival results and the approval of belzutifan in advanced RCC.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.