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NCCN Guidelines Insights: Kidney Cancer, Version 2.2020

Featured Updates to the NCCN Guidelines

Robert J. Motzer, Eric Jonasch, M. Dror Michaelson, Lakshminarayanan Nandagopal, John L. Gore, Saby George, Ajjai Alva, Naomi Haas, Michael R. Harrison, Elizabeth R. Plimack, Jeffrey Sosman, Neeraj Agarwal, Sam Bhayani, Toni K. Choueiri, Brian A. Costello, Ithaar H. Derweesh, Thomas H. Gallagher, Steven L. Hancock, Christos Kyriakopoulos, Chad LaGrange, Elaine T. Lam, Clayton Lau, Bryan Lewis, Brandon Manley, Brittany McCreery, Andrew McDonald, Amir Mortazavi, Phillip M. Pierorazio, Lee Ponsky, Bruce G. Redman, Bradley Somer, Geoffrey Wile, Mary A. Dwyer, CGC, Lydia J. Hammond, and Griselda Zuccarino-Catania

the next era. Currently recommended first-line targeted therapy options in the NCCN Guidelines are single-agent TKIs or VEGF inhibitors, including pazopanib, 29 sunitinib, 30 axitinib, 31 and cabozantinib, 32 or temsirolimus, which targets mTOR. 33

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Sumanta K. Pal, Matthew I. Milowsky, and Elizabeth R. Plimack

refractory metastatic bladder cancer were treated with weekly temsirolimus, a potent intravenously administered mTOR inhibitor approved for advanced RCC. 91 , 92 The study was stopped because of a lack of observed efficacy; PFS and OS of 2.5 and 3.5 months

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Margaret von Mehren, R. Lor Randall, Robert S. Benjamin, Sarah Boles, Marilyn M. Bui, Ernest U. Conrad III, Kristen N. Ganjoo, Suzanne George, Ricardo J. Gonzalez, Martin J. Heslin, John M. Kane III, Henry Koon, Joel Mayerson, Martin McCarter, Sean V. McGarry, Christian Meyer, Richard J. O'Donnell, Alberto S. Pappo, I. Benjamin Paz, Ivy A. Petersen, John D. Pfeifer, Richard F. Riedel, Scott Schuetze, Karen D. Schupak, Herbert S. Schwartz, William D. Tap, Jeffrey D. Wayne, Mary Anne Bergman, and Jillian Scavone

-inhibitor that has been successful in treating ALK-rearranged non–small cell lung cancer. 126 mTOR inhibitors such as sirolimus, temsirolimus, and everolimus have also shown promising results in patients with metastatic perivascular epithelioid cell tumors and

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Amelia B. Zelnak and Ruth M. O'Regan

setting, given available preclinical data it seems likely that mTOR inhibition may be more effective in the endocrine-resistant setting. This hypothesis is supported by the fact that the addition of temsirolimus to letrozole did not improve outcomes in the

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David M. Thomas and Andrew J. Wagner

survival signals, inhibitors of mTOR have been studied for efficacy in the treatment of malignancies, and 3 are currently available commercially: sirolimus (approved for post-renal transplant immunosuppression), temsirolimus, and everolimus (CCI-779 and RAD

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Katy K. Tsai, Neharika Khurana, Timothy McCalmont, Adil Daud, Boris Bastian, and Iwei Yeh

off-label use of mTOR inhibitors currently approved for other indications (eg, everolimus in renal cell carcinoma, pancreatic neuroendocrine tumors, and breast cancer; temsirolimus in renal cell carcinoma) may have been a viable option. The splice site

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Arti Hurria, Ilene S. Browner, Harvey Jay Cohen, Crystal S. Denlinger, Mollie deShazo, Martine Extermann, Apar Kishor P. Ganti, Jimmie C. Holland, Holly M. Holmes, Mohana B. Karlekar, Nancy L. Keating, June McKoy, Bruno C. Medeiros, Ewa Mrozek, Tracey O’Connor, Stephen H. Petersdorf, Hope S. Rugo, Rebecca A. Silliman, William P. Tew, Louise C. Walter, Alva B. Weir III, and Tanya Wildes

(sorafenib 294 , 295 and sunitinib 296 , 297 ), and mammalian target of rapamycin (mTOR) inhibitors (everolimus 298 and temsirolimus 299 ) have been evaluated in elderly patients with metastatic RCC. Sorafenib, sunitinib, and everolimus have similar

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A. Scott Paulson and Emily K. Bergsland

II consortium (P2C) study [abstract] . J Clin Oncol 2007 ; 25 ( Suppl ): Abstract 4504 . 51 Duran I Kortmansky J Singh D . A phase II clinical and pharmacodynamic study of temsirolimus in advanced neuroendocrine carcinomas . Br J

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Matthew Zibelman and Elizabeth R. Plimack

/pazopanib) or an mTOR inhibitor (everolimus or temsirolimus). A third mechanistic option, interferon alfa plus bevacizumab, was rarely used. 10 Due to its durability of benefit, nivolumab became the de facto second-line option for most patients with mRCC after

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Matthias Holdhoff, Maciej M. Mrugala, Christian Grommes, Thomas J. Kaley, Lode J. Swinnen, Carlos Perez-Heydrich, and Lakshmi Nayak

rituximab as second-line treatment of primary central nervous system lymphoma . Med Oncol 2015 ; 32 : 351 . 61. Korfel A , Schlegel U , Herrlinger U , . Phase II trial of temsirolimus for relapsed/refractory primary CNS lymphoma . J Clin Oncol