Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Oct;40(10):2381-2386.
doi: 10.1007/s00345-022-04015-1. Epub 2022 May 13.

Systemic therapy in metastatic renal cell carcinoma (mRCC): an evidence-based recommendation of the German interdisciplinary RCC guidelines group

V Grünwald  1 , L Bergmann  2 , B Brehmer  2 , B Eberhardt  2 , Karin Kastrati  2 , T Gauler  2 , G Gehbauer  2 , J Gschwend  2 , M Johannsen  2 , T Klotz  2 , C Protzel  2 , M Schenck  2 , M Staehler  2
Affiliations

Systemic therapy in metastatic renal cell carcinoma (mRCC): an evidence-based recommendation of the German interdisciplinary RCC guidelines group

V Grünwald et al. World J Urol. 2022 Oct.

Abstract

Purpose: The treatment landscape in metastatic renal cell carcinoma (mRCC) has evolved dramatically in recent years. Within the German guideline committee for RCC we evaluated current medical treatments and gave recommendations.

Methods: A systematic review of published evidence for medical treatment of mRCC was performed (July 2016-August 2019) to cover the duration from last guideline update in 2016. Evidence was graded according to SIGN ( http://www.sign.ac.uk/pdf/sign50.pdf ). Recommendations were made on the basis of a nominal group work with consensus approach and included patient advocates and shareholder of the German RCC treatment landscape. Each recommendation was graded according to its strength as strong recommendation (A) or recommendation (B). Expert statements were given, where appropriate.

Results: Strong first-line recommendations (IA) exist for axitinib + pembrolizumab (all risk categories) and ipilimumab + nivolumab (intermediate or poor risk only). Axitinib + avelumab is a recommended first-line treatment across patients with any risk category (IB). In patients who are not candidates for immune check point inhibitor (ICI) combinations, targeted agents should be offered as an alternative treatment. Subsequent treatment after ICI-based combinations remain ill-defined and no standard of care can be formulated.

Conclusion: ICI-based combinations are the first-line standard of care and should be considered accordingly. There is an unmet medical need for pivotal studies that define novel standards in patients with failure of ICI-based combinations.

Keywords: Checkpoint inhibitor; Guideline; Medical therapy; Renal cell carcinoma; Tyrosine kinase inhibitor.

PubMed Disclaimer

Conflict of interest statement

VG: received research support, personal fees from Astra Zeneca, Bristol-Myers Squibb, MSD Sharp & Dohme, Ipsen, Pfizer. Personal fees from Merck Serono, EUSAPharm, Novartis, Lilly, Eisai, Roche, Janssen-Cilag. LB: no conflicts of interest to declare that are relevant to the content of this article. BB: received personal fees from BMS, Novartis, Pfizer.BE: received personal fees from GSK, Pfizer. TG: received personal fees from BMS, Merck Serono, MSD, Ipsen, Novartis, EISAI. GG: received personal fees from Ipsen, AstraZeneca, BMS. JG: received personal fees from Bayer, Roche, MSD, Janssen, Amgen, BMS. KK: no conflicts of interest to declare that are relevant to the content of this article. MJ: received personal fees from Pfizer, BMS, Janssen-Cilag, Hexal, EISAI, Sanofi, Bayer, Novartis, Astellas, Medac, Roche. TK: received personal fees from Janssen-Cilag, Bayer, Astellas, Pfizer, BMS, Novartis. CP: received personal fees from MSD. MS: no conflicts of interest to declare that are relevant to the content of this article. MStae: received personal fees from Pfizer, GSK, Novartis, Bayer, Roche, Aveo, EUSAPharm, Astellas, Ipsen, Exelexis, Pelleton, EISAI.

References

    1. Heng DYC, Xie W, Regan MM, et al. Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. J Clin Oncol. 2009;27:5794–5799. doi: 10.1200/JCO.2008.21.4809. - DOI - PubMed
    1. Rini BI, Plimack ER, Stus V, et al. (2019) Pembrolizumab plus axitinib versus sunitinib for advanced renal-cell carcinoma. N Engl J Med. 2019;380:oa1816714. doi: 10.1056/NEJMoa1816714. - DOI - PubMed
    1. Motzer RJ, Tannir NM, McDermott DF, et al. Nivolumab plus Ipilimumab versus sunitinib in advanced renal-cell carcinoma. N Engl J Med. 2018;380:oa1712126. - PMC - PubMed
    1. Motzer RJ, Penkov K, Haanen J, et al. Avelumab plus axitinib versus sunitinib for advanced renal-cell carcinoma. N Engl J Med. 2019;3880:oa1816047. - PMC - PubMed
    1. Albiges L, Tannir NM, Burotto M, et al. Nivolumab plus ipilimumab versus sunitinib for first-line treatment of advanced renal cell carcinoma: extended 4-year follow-up of the phase III CheckMate 214 trial. Esmo Open. 2020;5:e001079. doi: 10.1136/esmoopen-2020-001079. - DOI - PMC - PubMed

Publication types