What are the NCCN recommendations for treatment of relapsed stage IV renal cell carcinoma (RCC)?

Updated: Feb 19, 2021
  • Author: Kush Sachdeva, MD; Chief Editor: E Jason Abel, MD  more...
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For stage IV RCC that is relapsed, includes multiple metastatic sites, or is surgically unresectable, the National Comprehensive Cancer Network (NCCN) guideline gives several targeted therapy agents a category 1 recommendation (ie, based on high-level evidence, with uniform NCCN consensus that the intervention is appropriate) for this group of patients. [19]  For patients with predominantly clear cell cancer, considerations for first-line therapy are best supportive care and one of the following:

  • Clinical trial
  • Pazopanib (category 1, preferred)
  • Sunitinib (category 1, preferred)
  • Bevacizumab + interferon alfa-2b (category 1)
  • Temsirolimus (category 1 for poor-prognosis patients, category 2B for selected patients of other risk groups)
  • Axitinib
  • Cabozantinib (for poor- and intermediate-risk groups)
  • High-dose IL-2 for selected patients (with excellent performance status and normal organ function)
  • Active surveillance for select, asymptomatic patients)

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