NCCN Guidelines Insights: Kidney Cancer, Version 2.2020

Featured Updates to the NCCN Guidelines

Authors:
Robert J. MotzerMemorial Sloan Kettering Cancer Center;

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Eric JonaschThe University of Texas MD Anderson Cancer Center;

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M. Dror MichaelsonMassachusetts General Hospital Cancer Center;

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,
Lakshminarayanan NandagopalO'Neal Comprehensive Cancer Center at UAB;

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John L. GoreFred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance;

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Saby GeorgeRoswell Park Comprehensive Cancer Center;

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Ajjai AlvaUniversity of Michigan Rogel Cancer Center;

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Naomi HaasAbramson Cancer Center at the University of Pennsylvania;

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Michael R. HarrisonDuke Cancer Institute;

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Elizabeth R. PlimackFox Chase Cancer Center;

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Jeffrey SosmanRobert H. Lurie Comprehensive Cancer Center of Northwestern University;

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Neeraj AgarwalHuntsman Cancer Institute at the University of Utah;

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Sam BhayaniSiteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine;

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Toni K. ChoueiriDana-Farber/Brigham and Women’s Cancer Center;

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Brian A. CostelloMayo Clinic Cancer Center;

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Ithaar H. DerweeshUC San Diego Moores Cancer Center;

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Thomas H. GallagherFred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance;

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Steven L. HancockStanford Cancer Institute;

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Christos KyriakopoulosUniversity of Wisconsin Carbone Cancer Center;

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Chad LaGrangeFred & Pamela Buffett Cancer Center;

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Elaine T. LamUniversity of Colorado Cancer Center;

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Clayton LauCity of Hope National Medical Center;

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Bryan LewisKidney Cancer Coalition;

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Brandon ManleyMoffitt Cancer Center;

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Brittany McCreeryFred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance;

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Andrew McDonaldO'Neal Comprehensive Cancer Center at UAB;

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Amir MortazaviThe Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute;

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Phillip M. PierorazioThe Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins;

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Lee PonskyCase Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute;

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Bruce G. RedmanUniversity of Michigan Rogel Cancer Center;

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Bradley SomerSt. Jude Children’s Research Hospital/The University of Tennessee Health Science Center;

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Geoffrey WileVanderbilt-Ingram Cancer Center; and

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Mary A. Dwyer
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CGCNational Comprehensive Cancer Network.

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Lydia J. HammondNational Comprehensive Cancer Network.

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Griselda Zuccarino-CataniaNational Comprehensive Cancer Network.

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Volume/Issue:
Volume 17: Issue 11
Online Publication Date:
Nov 2019
DOI:
https://doi.org/10.6004/jnccn.2019.0054
Restricted access

The NCCN Guidelines for Kidney Cancer provide multidisciplinary recommendations for the clinical management of patients with clear cell and non–clear cell renal cell carcinoma, and are intended to assist with clinical decision-making. These NCCN Guidelines Insights summarize the NCCN Kidney Cancer Panel discussions for the 2020 update to the guidelines regarding initial management and first-line systemic therapy options for patients with advanced clear cell renal cell carcinoma.

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  • 1.

    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin 2019;69:7–34.

  • 2.

    Moch H, Gasser T, Amin MB, et al.. Prognostic utility of the recently recommended histologic classification and revised TNM staging system of renal cell carcinoma: a Swiss experience with 588 tumors. Cancer 2000;89:604–614.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Leibovich BC, Lohse CM, Crispen PL, et al.. Histological subtype is an independent predictor of outcome for patients with renal cell carcinoma. J Urol 2010;183:1309–1315.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Lipworth L, Morgans AK, Edwards TL, et al.. Renal cell cancer histological subtype distribution differs by race and sex. BJU Int 2016;117:260–265.

  • 5.

    National Cancer Institute. Cancer Stat Facts: Kidney and Renal Pelvis Cancer. Available at: http://seer.cancer.gov/statfacts/html/kidrp.html. Accessed June 28, 2019.

    • Search Google Scholar
    • Export Citation
  • 6.

    Méjean A, Ravaud A, Thezenas S, et al.. Sunitinib alone or after nephrectomy in metastatic renal-cell carcinoma. N Engl J Med 2018;379:417–427.

  • 7.

    Motzer RJ, Penkov K, Haanen J, et al.. Avelumab plus axitinib versus sunitinib for advanced renal-cell carcinoma. N Engl J Med 2019;380:1103–1115.

  • 8.

    Rini BI, Plimack ER, Stus V, et al.. Pembrolizumab (pembro) plus axitinib (axi) versus sunitinib as first-line therapy for metastatic renal cell carcinoma (mRCC): outcomes in the combined IMDC intermediate/poor risk and sarcomatoid subgroups of the phase 3 KEYNOTE-426 study [abstract]. J Clin Oncol 2019;37(Suppl):Abstract 4500.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Motzer RJ, Bacik J, Murphy BA, et al.. Interferon-alfa as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma. J Clin Oncol 2002;20:289–296.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Motzer RJ, Russo P. Cytoreductive nephrectomy - patient selection is key. N Engl J Med 2018;379:481–482.

  • 11.

    Motzer RJ, Tannir NM, McDermott DF, et al.. Nivolumab plus ipilimumab versus sunitinib in advanced renal-cell carcinoma. N Engl J Med 2018;378:1277–1290.

  • 12.

    Rini BI, Plimack ER, Stus V, et al.. Pembrolizumab plus axitinib versus sunitinib for advanced renal-cell carcinoma. N Engl J Med 2019;380:1116–1127.

  • 13.

    Siva S, Ellis RJ, Ponsky L, et al.. Consensus statement from the International Radiosurgery Oncology Consortium for Kidney for primary renal cell carcinoma. Future Oncol 2016;12:637–645.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Siva S, Louie AV, Warner A, et al.. Pooled analysis of stereotactic ablative radiotherapy for primary renal cell carcinoma: a report from the International Radiosurgery Oncology Consortium for Kidney (IROCK). Cancer 2018;124:934–942.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Meyer E, Pasquier D, Bernadou G, et al.. Stereotactic radiation therapy in the strategy of treatment of metastatic renal cell carcinoma: a study of the Getug group. Eur J Cancer 2018;98:38–47.

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    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Heng DY, Xie W, Regan MM, et al.. Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. J Clin Oncol 2009;27:5794–5799.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Ficarra V, Schips L, Guillè F, et al.. Multiinstitutional European validation of the 2002 TNM staging system in conventional and papillary localized renal cell carcinoma. Cancer 2005;104:968–974.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Frank I, Blute ML, Leibovich BC, et al.. Independent validation of the 2002 American Joint Committee on Cancer primary tumor classification for renal cell carcinoma using a large, single institution cohort. J Urol 2005;173:1889–1892.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Zisman A, Pantuck AJ, Chao D, et al.. Reevaluation of the 1997 TNM classification for renal cell carcinoma: T1 and T2 cutoff point at 4.5 rather than 7 cm. better correlates with clinical outcome. J Urol 2001;166:54–58.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Klatte T, Patard JJ, Goel RH, et al.. Prognostic impact of tumor size on pT2 renal cell carcinoma: an international multicenter experience. J Urol 2007;178:35–40.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Lam JS, Klatte T, Patard JJ, et al.. Prognostic relevance of tumour size in T3a renal cell carcinoma: a multicentre experience. Eur Urol 2007;52:155–162.

  • 22.

    Minervini A, Lilas L, Minervini R, et al.. Prognostic value of nuclear grading in patients with intracapsular (pT1-pT2) renal cell carcinoma. Long-term analysis in 213 patients. Cancer 2002;94:2590–2595.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Dall’Oglio MF, Antunes AA, Sarkis AS, et al.. Microvascular tumour invasion in renal cell carcinoma: the most important prognostic factor. BJU Int 2007;100:552–555.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Dall’Oglio MF, Ribeiro-Filho LA, Antunes AA, et al.. Microvascular tumor invasion, tumor size and Fuhrman grade: a pathological triad for prognostic evaluation of renal cell carcinoma. J Urol 2007;178:425–428.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Lam JS, Shvarts O, Said JW, et al.. Clinicopathologic and molecular correlations of necrosis in the primary tumor of patients with renal cell carcinoma. Cancer 2005;103:2517–2525.

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    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Sengupta S, Lohse CM, Leibovich BC, et al.. Histologic coagulative tumor necrosis as a prognostic indicator of renal cell carcinoma aggressiveness. Cancer 2005;104:511–520.

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    • Search Google Scholar
    • Export Citation
  • 27.

    McDermott DF, Regan MM, Clark JI, et al.. Randomized phase III trial of high-dose interleukin-2 versus subcutaneous interleukin-2 and interferon in patients with metastatic renal cell carcinoma. J Clin Oncol 2005;23:133–141.

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    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Yang JC, Sherry RM, Steinberg SM, et al.. Randomized study of high-dose and low-dose interleukin-2 in patients with metastatic renal cancer. J Clin Oncol 2003;21:3127–3132.

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    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Sternberg CN, Hawkins RE, Wagstaff J, et al.. A randomised, double-blind phase III study of pazopanib in patients with advanced and/or metastatic renal cell carcinoma: final overall survival results and safety update. Eur J Cancer 2013;49:1287–1296.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Motzer RJ, Hutson TE, Tomczak P, et al.. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med 2007;356:115–124.

  • 31.

    Hutson TE, Lesovoy V, Al-Shukri S, et al.. Axitinib versus sorafenib as first-line therapy in patients with metastatic renal-cell carcinoma: a randomised open-label phase 3 trial. Lancet Oncol 2013;14:1287–1294.

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    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Choueiri TK, Halabi S, Sanford BL, et al.. Cabozantinib versus sunitinib as initial targeted therapy for patients with metastatic renal cell carcinoma of poor or intermediate risk: the Alliance A031203 CABOSUN trial. J Clin Oncol 2017;35:591–597.

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    • PubMed
    • Search Google Scholar
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  • 33.

    Hudes G, Carducci M, Tomczak P, et al.. Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med 2007;356:2271–2281.

  • 34.

    Motzer RJ, Rini BI, McDermott DF, et al.. Nivolumab plus ipilimumab versus sunitinib in first-line treatment for advanced renal cell carcinoma: extended follow-up of efficacy and safety results from a randomised, controlled, phase 3 trial [published online August 16, 2019]. Lancet Oncol, doi: 10.1016/S1470-2045(19)30413-9

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Copyright:
Copyright © 2019 by the National Comprehensive Cancer Network 2019
Page Numbers:
8
Article Category:
Other
Print Publication Date:
01 Nov 2019
Online Publication Date:
Nov 2019
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