Kidney Cancer Clinical Practice Guidelines in Oncology
NCCN Categories of Evidence and Consensus
Category 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.
Overview
In 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...
Robert J. Motzer, Neeraj Agarwal, Clair Beard, Graeme B. Bolger, Barry Boston, Michael A. Carducci, Toni K. Choueiri, Robert A. Figlin, Mayer Fishman, Steven L. Hancock, Gary R. Hudes, Eric Jonasch, Anne Kessinger, Timothy M. Kuzel, Paul H. Lange, Ellis G. Levine, Kim A. Margolin, M. Dror Michaelson, Thomas Olencki, Roberto Pili, Bruce G. Redman, Cary N. Robertson, Lawrence H. Schwartz, Joel Sheinfeld and Jue Wang
Robert J. Motzer, Neeraj Agarwal, Clair Beard, Sam Bhayani, Graeme B. Bolger, Michael A. Carducci, Sam S. Chang, Toni K. Choueiri, Steven L. Hancock, Gary R. Hudes, Eric Jonasch, David Josephson, Timothy M. Kuzel, Ellis G. Levine, Daniel W. Lin, Kim A. Margolin, M. Dror Michaelson, Thomas Olencki, Roberto Pili, Thomas W. Ratliff, Bruce G. Redman, Cary N. Robertson, Charles J. Ryan, Joel Sheinfeld, Philippe E. Spiess, Jue Wang and Richard B. Wilder
malignancies, with a median age at diagnosis of 65 years. The rate of RCC has increased by 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
Robert J. Motzer, Eric Jonasch, Neeraj Agarwal, Clair Beard, Sam Bhayani, Graeme B. Bolger, Sam S. Chang, Toni K. Choueiri, Ithaar H. Derweesh, Shilpa Gupta, Steven L. Hancock, Jenny J. Kim, Timothy M. Kuzel, Elaine T. Lam, Clayton Lau, Ellis G. Levine, Daniel W. Lin, Kim A. Margolin, M. Dror Michaelson, Thomas Olencki, Roberto Pili, Elizabeth R. Plimack, Edward N. Rampersaud, Bruce G. Redman, Charles J. Ryan, Joel Sheinfeld, Kanishka Sircar, Brad Somer, Jue Wang, Richard B. Wilder, Mary A. Dwyer and Rashmi Kumar
RCC has increased by 1.7% per year for the past 10 years. 2 Approximately 90% of renal tumors are RCC, and 85% of these are clear cell tumors. 3 Other less common cell types include papillary, chromophobe, “translocation-type,” and Bellini
Pablo Maroto, Georgia Anguera, Juan Maria Roldan-Romero, Maria Apellániz-Ruiz, Ferran Algaba, Jacqueline Boonman, Mark Nellist, Cristina Montero-Conde, Alberto Cascón, Mercedes Robledo and Cristina Rodríguez-Antona
patient with metastatic chRCC. The optimum targeted therapy for chRCC is still not well-defined. Most trials for metastatic RCC are performed with clear cell tumors and include a limited number of chRCC cases. 21 , 25 – 27 A recent randomized phase II
Robert J. Motzer, Eric Jonasch, Neeraj Agarwal, Sam Bhayani, William P. Bro, Sam S. Chang, Toni K. Choueiri, Brian A. Costello, Ithaar H. Derweesh, Mayer Fishman, Thomas H. Gallagher, John L. Gore, Steven L. Hancock, Michael R. Harrison, Won Kim, Christos Kyriakopoulos, Chad LaGrange, Elaine T. Lam, Clayton Lau, M. Dror Michaelson, Thomas Olencki, Phillip M. Pierorazio, Elizabeth R. Plimack, Bruce G. Redman, Brian Shuch, Brad Somer, Guru Sonpavde, Jeffrey Sosman, Mary Dwyer and Rashmi Kumar
are RCC, and approximately 80% of these are clear cell tumors. 2 , 3 Other less common cell types include papillary, chromophobe, translocation, and Bellini duct (collecting duct) tumors. Medullary renal carcinoma is a variant of collecting duct renal
Robert A. Figlin, Elizabeth Brown, Andrew J. Armstrong, Wallace Akerley, Al B. Benson III, Harold J. Burstein, David S. Ettinger, Phillip G. Febbo, Matthew G. Fury, Gary R. Hudes, Merrill S. Kies, Eunice L. Kwak, Robert J. Morgan Jr., Joanne Mortimer, Karen Reckamp, Alan P. Venook, Frank Worden and Yun Yen
that of interferon in patients with clear cell and non-clear cell histology; the latter histology constituted 20% to 25% of renal cell carcinomas. The 75 patients with non-clear cell tumors is the largest such population in any randomized trial. In this
