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. 2023 Aug 9;23(1):737.
doi: 10.1186/s12885-023-11237-y.

ExPert ConsEnsus on the management of Advanced clear-cell RenaL celL carcinoma: INDIAn Perspective (PEARL-INDIA)

Tarini Prasad Sahoo  1 , Chirag Desai  2 , Shyam Agarwal  3 , Amit Rauthan  4 , Boman Dhabhar  5 , Ghanshyam Biswas  6 , Sandeep Batra  7 , Rajat Saha  7 , Arun Philip  8 , Vijay Agarwal  9 , Palanki Satya Dattatreya  10 , P N Mohapatra  11 , Chetan Deshmukh  12 , Sagar Bhagat  13 , Saiprasad Patil  14 , Hanmant Barkate  15
Affiliations

ExPert ConsEnsus on the management of Advanced clear-cell RenaL celL carcinoma: INDIAn Perspective (PEARL-INDIA)

Tarini Prasad Sahoo et al. BMC Cancer. .

Abstract

In advanced Renal Cell Carcinoma (aRCC), systemic therapy is the mainstay of treatment, with no or little role for surgery in these patients. Tyrosine kinase inhibitors (TKIs) and immune-oncological (IOs) therapies, either alone or in combination, are recommended in these patients depending on patient and tumour factors. The sequencing of therapies is critical in RCC because the choice of subsequent line therapy is heavily dependent on the response and duration of the previous treatment. There are additional barriers to RCC treatment in India. Immunotherapy is the cornerstone of treatment in ccRCC, but it is prohibitively expensive and not always reimbursed, effectively putting it out of reach for the vast majority of eligible patients in India. Furthermore, in advanced RCC (particularly the clear cell variety), Indian oncologists consider the disease burden of the patients, which is particularly dependent on the quantum of the disease load, clinical symptoms, and performance status of the patient, before deciding on treatment. There are no India-specific guidelines for clear cell RCC (ccRCC) treatment or the positioning and sequencing of molecules in the management of advanced ccRCC that take these country-specific issues into account. The current consensus article provides expert recommendations and treatment algorithms based on existing clinical evidence, which will be useful to specialists managing advanced ccRCC.

Keywords: Cabozantinib; Consensus; Immunotherapy; Renal cell carcinoma; Tyrosine kinase inhibitors.

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Conflict of interest statement

Dr. TP Sahoo received speaker bureau from Roche, AstraZeneca, Eli Lilly, DRL; Honorarium from Roche, AstraZeneca, Eli Lilly, Glenmark, MSD, DRL, Merck. Dr. Sandeep Batra received honorarium from DRL, Intas, Roche, MSD, Pfizer. Dr. Chirag Desai received speaker bureau from Roche, Pfizer, Novartis, MSD, Biocon, DRL. Dr. Rajat Saha received honorarium from Intas. Dr. Arun Philips received speaker bureau from Eli Lilly. Dr. G Biswas received honorarium form DRL, Intas, Zydus, Eli Lilly; Speaker bureau from Eli Lilly, Intas, Zydus. Dr. Boman Dabhar received speaker bureau from Roche, AstraZeneca; Dr. Sagar Bhagat, Dr. Saiprasad Patil, Dr. Hanmant Barkate are employees of Glenmark Pharmaceuticals Ltd. who contributed toward literature search and manuscript writing. The design or procedure of the consensus and the content of the paper are in no way influenced by the grant provider. Glenmark had no influence on the participating experts’ opinions or final consensus. Dr. Shyam Agarwal, Dr. Amit Rautan, Dr. Vijay Agarwal, Dr. P S Dattatreya, Dr. PN Mohapatra, Dr. Chetan Deshmukh declares no competing interests.

Figures

Fig. 1
Fig. 1
Consensus process using modified Delphi method
Fig. 2
Fig. 2
First line treatment in advanced clear cell RCC
Fig. 3
Fig. 3
Second line treatment in advanced clear cell RCC
See this image and copyright information in PMC

References

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Supplementary concepts