Kidney Cancer Clinical Practice Guidelines in OncologyNCCN Categories of Evidence and ConsensusCategory 1: The recommendation is based on high-level evidence (e.g., randomized controlled trials) and there isuniform NCCN consensus.Category 2A: The recommendation is based on lower-level evidence and there is uniform NCCN consensus.Category 2B: The recommendation is based on lower-level evidence and there is nonuniform NCCN consensus (but no major disagreement).Category 3: The recommendation is based on any level of evidence but reflects major disagreement.All recommendations are category 2A unless otherwise noted.Clinical trials: The NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.OverviewIn 2008, an estimated 54,390 Americans were diagnosed with kidney cancer and 13,010 died of the disease in the United States.1 Renal cell carcinoma (RCC) comprises approximately 2% of all malignancies, with a median age at diagnosis of 65 years. The rate of RCC has increased 2% per year for the past 65 years. The reason for this increase is unknown. Approximately 90% of renal tumors are RCC, and 85% of these are clear cell tumors.2 Other, less-common cell types include papillary, chromophobe, and Bellini (collecting) duct tumors. Collecting duct carcinoma comprises fewer than 1% of all cases. Medullary renal carcinoma is a variant of collecting duct renal carcinoma and was initially described as occurring in patients who are sickle cell–trait positive.Smoking and obesity are among the risk factors for RCC development. Several hereditary types...

If the inline PDF is not rendering correctly, you can download the PDF file here.

References

  • 1

    JemalASiegelRWardE. Cancer statistics, 2008. CA Cancer J Clin2008;58:7196.

  • 2

    KarumanchiSAMerchanJSukhatmeVP. Renal cancer: molecular mechanisms and newer therapeutic options. Curr Opin Nephrol Hypertens2002;11:3742.

    • Search Google Scholar
    • Export Citation
  • 3

    DeVitaVTJrHellmanSRosenbergSA. Cancer Principles and Practice of Oncology. 7th ed.Philadelphia: Lippincott Williams & Wilkins; 2004.

    • Search Google Scholar
    • Export Citation
  • 4

    ChoykePL. Hereditary renal cancers. Radiology2003;226:3346.

  • 5

    RiesLAGMelbertDKrapchoM eds. SEER Cancer Statistics Review 1975–2004National Cancer Institute. Bethesda, MDhttp://seer.cancer.gov/csr/1975_2004/ based on November 2006 SEER data submission posted to the SEER web site2007.

    • Search Google Scholar
    • Export Citation
  • 6

    HricakHDemasBEWilliamsRD. Magnetic resonance imaging in the diagnosis and staging of renal and perirenal neoplasms. Radiology1985;154:709715.

    • Search Google Scholar
    • Export Citation
  • 7

    JanusCLMendelsonDS. Comparison of MRI and CT for study of renal and perirenal masses. Crit Rev Diag Imaging1991;32:69118.

  • 8

    DechetCBZinckeHSeboTJ. Prospective analysis of computerized tomography and needle biopsy with permanent sectioning to determine the nature of solid renal masses in adults. J Urol2003;169:7174.

    • Search Google Scholar
    • Export Citation
  • 9

    HollingsworthJMMillerDCDunnRL. Surgical management of low-stage renal cell carcinoma: technology does not supersede biology. Urology2006;67:11751180.

    • Search Google Scholar
    • Export Citation
  • 10

    ShuchBLamJSBelldegrunAS. Open partial nephrectomy for the treatment or renal cell carcinoma. Curr Urol Rep2006;7:3138.

  • 11

    LeibovichBCBluteMLChevilleJC. Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy. J Urol2004;17:10661070.

    • Search Google Scholar
    • Export Citation
  • 12

    LuiKWGervaisDAMuellerPR. Radiofrequency ablation: an alternative treatment method of renal cell carcinoma. Chang Gung Med J2004;27:618623.

    • Search Google Scholar
    • Export Citation
  • 13

    LewinJSNourSGConnellCF. Phase II clinical trial of interactive MR imaging-guided interstitial radiofrequency thermal ablation of primary kidney tumors: initial experience. Radiology2004;232:835845.

    • Search Google Scholar
    • Export Citation
  • 14

    GillISRemerEMHasanWA. Renal cryoablation: outcome at 3 years. J Urol2005;173:19031907.

  • 15

    RouviereOBouvierRNegrierS. Nonmetastatic renal cell carcinoma: is it really possible to define rational guidelines for post treatment follow up. Nat Clin Pract Oncol2006;3:200213.

    • Search Google Scholar
    • Export Citation
  • 16

    MessingEMManolaJWildingG. Phase III study of interferon alfa-NL as adjuvant treatment for resectable renal cell carcinoma: an Eastern Cooperative Oncology Group/Intergroup trial. J Clin Oncol2003;21:12141222.

    • Search Google Scholar
    • Export Citation
  • 17

    ClarkJIAtkinsMBUrbaWJ. Adjuvant high-dose bolus interleukin-2 for patients with high-risk renal cell carcinoma: a Cytokine Working Group randomized trial. J Clin Oncol2003;21:31333140.

    • Search Google Scholar
    • Export Citation
  • 18

    TrumpDLElsonPPropertK. Randomized, controlled trial of adjuvant therapy with lymphoblastoid interferon (L-IFN) in resected, high-risk renal cell carcinoma [abstract]. Proc Am Soc Clin Oncol1996;15:Abstract 253.

    • Search Google Scholar
    • Export Citation
  • 19

    KavoliusJPMastorakosDPPavlovichC. Resection of metastatic renal cell carcinoma. J Clin Oncol1998;16:22612266.

  • 20

    FossaSDKjolsethILundG. Radiotherapy of metastases from renal cancer. Eur Urol1982;8:340342.

  • 21

    FlaniganRCMickischGSylvesterR. Cytoreductive nephrectomy in patients with metastatic renal cancer. A combined analysis. J Urol2004;171:10711076.

    • Search Google Scholar
    • Export Citation
  • 22

    FlaniganRCSalmonSEBlumensteinBA. Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med2001;345:16551659.

    • Search Google Scholar
    • Export Citation
  • 23

    MickischGHGarinAvan PoppelH. Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial. Lancet2001;358:966970.

    • Search Google Scholar
    • Export Citation
  • 24

    NegrierSEscudierBLassetC. Recombinant human interleukin-2, recombinant human interferon alfa-2a, or both in metastatic renal-cell carcinoma. N Engl J Med1998;338:12731278.

    • Search Google Scholar
    • Export Citation
  • 25

    YangJCSherryRMSteinbergSM. Randomized study of high-dose and low-dose interleukin-2 in patients with metastatic renal cancer. J Clin Oncol2003;21:31273132.

    • Search Google Scholar
    • Export Citation
  • 26

    DutcherJPFisherRIWeissG. Outpatient subcutaneous interleukin-2 and interferon-alpha for metastatic renal cell cancer: five-year follow-up of the Cytokine Working Group Study. Cancer J Sci Am1997;3:157162.

    • Search Google Scholar
    • Export Citation
  • 27

    MotzerRJBasikJMurphyBA. Interferon-alfa as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma. J Clin Oncol2002;20:289296.

    • Search Google Scholar
    • Export Citation
  • 28

    ChowLQEckhardtSG. Sunitinib: from rational design to clinical efficacy. J Clin Oncol2007;25:884896.

  • 29

    FaivreSDelbaldoCVeraK. Safety, pharmacokinetic, and antitumor activity of SU11248, a novel oral multitarget tyrosine kinase inhibitor, in patients with cancer. J Clin Oncol2006;24:2535.

    • Search Google Scholar
    • Export Citation
  • 30

    MotzerRJHutsonTETomczakP. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med2007;356:115124.

  • 31

    FiglinRAHutsonTETomczakMD. Overall survival with sunitinib versus interferon (IFN-)alfa as first-line treatment of metastatic renal cell carcinoma (mRCC) [abstract]. J Clin Oncol2008;26(Suppl 1):Abstract 5024.

    • Search Google Scholar
    • Export Citation
  • 32

    WilhelmSMCarterCTangL. BAY 43-9006 exhibits broad spectrum oral antitumor activity and targets the RAF/MEK/ERK pathway and receptor tyrosine kinases involved in tumor progression and angiogenesis. Cancer Res2004;64:70997109.

    • Search Google Scholar
    • Export Citation
  • 33

    MooreMHirteHWSiuL. Phase I study to determine the safety and pharmacokinetics of the novel Raf kinase and VEGFR inhibitor BAY 43-9006, administered for 28 days on/7 days off in patients with advanced, refractory solid tumors. Ann Oncol2005;16:16881694.

    • Search Google Scholar
    • Export Citation
  • 34

    StrumbergDRichlyHHilgerRA. Phase I clinical and pharmacokinetic study of the novel Raf kinase and vascular endothelial growth factor receptor inhibitor BAY 43-9006 in patients with advanced refractory solid tumors. J Clin Oncol2005;23:965972.

    • Search Google Scholar
    • Export Citation
  • 35

    AwadaAHendliszAGilT. Phase I safety and pharmacokinetics of BAY 43-9006 administered for 21 days on/7 days off in patients with advanced, refractory solid tumours. Br J Cancer2005;92:18551861.

    • Search Google Scholar
    • Export Citation
  • 36

    ClarkJWEderJPRyanD. Safety and pharmacokinetics of the dual action Raf kinase and vascular endothelial growth factor receptor inhibitor, BAY 43-9006, in patients with advanced, refractory solid tumors. Clin Cancer Res2005;11:54725480.

    • Search Google Scholar
    • Export Citation
  • 37

    SzczylikTDemkowMStaehlerF. Randomized phase II trial of first-line treatment with sorafenib versus interferon in patients with advanced renal cell carcinoma: final results. J Clin Oncol2007;25(18S):5025.

    • Search Google Scholar
    • Export Citation
  • 38

    GibbonsJJDiscafaniCPetersonR. The effect of CCI-779, a novel macrolide anti-tumor agent, on growth of human tumor cells in vitro and in nude mouse xenografts in vivo [abstract]. Proc Am Assoc Cancer Res1999;40:Abstract 301.

    • Search Google Scholar
    • Export Citation
  • 39

    HudesGCarducciMTomczakP. Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med2007;356:22712281.

  • 40

    YangJCHaworthLSherryRM. A randomized trial of bevacizumab, an anti-vascular endothelial growth factor antibody, for metastatic renal cancer. N Engl J Med2003;349:427434.

    • Search Google Scholar
    • Export Citation
  • 41

    EscudierBPluzanskaAKoralewskiP. Bevacizumab plus interferon alfa-2a for treatment of metastatic renal cell carcinoma: a randomised, double-blind phase III trial. Lancet2007;370:21032111.

    • Search Google Scholar
    • Export Citation
  • 42

    RiniBIHalabiSRosenbergJE. Bevacizumab plus interferon alfa compared with interferon alfa monotherapy in patients with metastatic renal cell carcinoma: CALGB 90206. J Clin Oncol2008;26:54225428.

    • Search Google Scholar
    • Export Citation
  • 43

    WenzelCLockerGSchmidingerM. Capecitabine in the treatment of metastatic renal cell carcinoma failing immunotherapy. Am J Kidney2002;39:4854.

    • Search Google Scholar
    • Export Citation
  • 44

    OevermannKBuerLHoffmannR. Capecitabine in the treatment of metastatic renal cell carcinoma. Br J Cancer2000;83:583587.

  • 45

    StadlerWMHalabiSErnstoffMS. A phase II study of gemcitabine (G) and capecitabine (C) in patients with metastatic renal cell cancer (mRCC): a report of Cancer and Leukemia Group B #90008 [abstract]. J Clin Oncol2004;22(Suppl 1):Abstract 4515.

    • Search Google Scholar
    • Export Citation
  • 46

    NanusDMGarinoAMilowskyMI. Active chemotherapy for sarcomatoid and rapidly progressing renal cell carcinoma. Cancer2004;101:15451551.

    • Search Google Scholar
    • Export Citation
  • 47

    MotzerRJEscudierBOudardS. Efficacy of everolimus in advanced renal cell carcinoma: a double-blind, randomised, placebo-controlled phase III trial. Lancet2008;372:449456.

    • Search Google Scholar
    • Export Citation
  • 48

    RatainMJEisenTStadlerWM. Phase II placebo-controlled randomized discontinuation trial of sorafenib in patients with metastatic renal cell carcinoma. J Clin Oncol2006;24:25052512.

    • Search Google Scholar
    • Export Citation
  • 49

    EscudierBEisenTStadlerWM. Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med2007;356:125134.

  • 50

    EisenTBukowskiRMStaehlerM. Randomized phase III trial of sorafenib in advanced renal cell carcinoma (RCC): impact of crossover on survival [abstract]. J Clin Oncol2006;24(Suppl 1): Abstract 4524.

    • Search Google Scholar
    • Export Citation
  • 51

    BukowskiRMEisenTSzczylikC. Final results of the randomized phase III trial of sorafenib in advanced renal cell carcinoma: survival and biomarker analysis [abstract]. J Clin Oncol2007;25(Suppl 1):Abstract 5023.

    • Search Google Scholar
    • Export Citation
  • 52

    MotzerRJRiniBIBukowskiRM. Sunitinib in patients with metastatic renal cell carcinoma. JAMA2006;295:25162524.

Article Information

Cited By

PubMed

Google Scholar

Related Articles

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 144 144 33
PDF Downloads 50 50 9
EPUB Downloads 0 0 0