NCCN Guidelines® Updates: Kidney Cancer

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Kidney Cancer, published in this issue (page 71), include the latest updates. To assist readers interested in noting how the guidelines were updated, highlights of major changes pertaining to the portion of the guidelines published in this issue are provided below. To view the most recent version of the guidelines, visit NCCN.org.

Updates in Version 3.2022 from Version 4.2021 include:

KID-1

  • Primary Treatment:

    • ➤ Stage 1 was revised: “Radical nephrectomy (in select patients) if nephron-sparing not indicated or feasible).”

  • Footnote “a” was revised: “Imaging with and without contrast....”

  • Footnote “e” is new.

KID-C, 1 of 2

  • Principles of Systemic Therapy:

    • ➤ First-Line Therapy for Clear Cell Histology:

      • ⋄ Favorable Risk, Preferred Regimens:

        • ∘ Axitinib + pembrolizumab was changed from a category 2A to a category 1 recommendation.

        • ∘ Pazopanib was moved to “Other Recommended Regimens.”

        • ∘ Sunitinib was moved to “Other Recommended Regimens.”

        • ∘ Useful in Certain Circumstances:

          • ▪ High-dose IL-2 was changed from a category 2A to a category 2B recommendation.

      • ⋄ Poor/Intermediate Risk, Useful in Certain Circumstances:

        • ∘ High-dose IL-2 was changed from a category 2A to a category 3 recommendation.

        • ∘ Temsirolimus was changed from a category 2A to a category 3 recommendation.

    • ➤ Subsequent Therapy for Clear Cell Histology:

      • ⋄ Preferred Regimens:

        • ∘ Ipilimumab + nivolumab was moved to “Other Recommended Regimens.”

        • ∘ Lenvatinib + everolimus (category 1) was moved from “Other Recommended Regimens.”

      • ⋄ Other Recommended Regimens:

        • ∘ Everolimus was moved to “Useful in Certain Circumstances.”

        • ∘ Cabozantinib + nivolumab was added.

        • ∘ Lenvatinib + pembrolizumab was added.

      • ⋄ Useful in Certain Circumstances:

        • ∘ Sorafenib was changed from a category 2A to a category 3 recommendation.

    • Footnote “c” was revised: “Rini BI, Dorff TB, Elson P, et al. Active surveillance in metastatic renal-cell carcinoma: a prospective, phase 2 trial. Lancet Oncol 2016;17:1317-1324. Harrison MR, et al. Active surveillance of metastatic renal cell carcinoma: Results from a prospective observational study (MaRCC). Cancer. 2021 Mar 25. Bex A. Increasing the evidence for surveillance of metastatic renal cancer. Cancer. 2021 Mar 25.”

    KID-C, 2 of 2

    • Principles of Systemic Therapy:

      • ➤ Systemic Therapy for Non-Clear Cell Histology:

        • ⋄ Preferred Regimens:

          • ∘ Cabozantinib was moved from “Other Recommended Regimens.”

        • ⋄ Other Recommended Regimens:

          • ∘ Everolimus was moved to “Useful in Certain Circumstances.”

          • ∘ Nivolumab was moved from “Useful in Certain Circumstances.”

          • ∘ Pembrolizumab was added.

        • ⋄ Useful in Certain Circumstances:

          • ∘ “Bevacizumab .... and renal cell cancer carcinoma (HLRCC)-associated RCC” was revised.

The goal of the NCCN Guidelines® Updates is to provide readers with important changes that the NCCN Guidelines Panel has incorporated into the algorithm since it was last published. For a more complete detailing of the updated guideline‘s modifications, access the NCCN Guidelines in this issue or, for the complete and most up-to-date version, at NCCN.org.

Note: The addition of new language is indicated in italics. Wording that has been removed from the previous version is indicated in strikeout.

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