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
Review
. 2024 Apr 9;150(4):183.
doi: 10.1007/s00432-024-05663-z.

Advanced renal cell carcinoma management: the Latin American Cooperative Oncology Group (LACOG) and the Latin American Renal Cancer Group (LARCG) consensus update

Andrey Soares  1   2   3 , Fernando Sabino Marques Monteiro  4   5 , Karine Martins da Trindade  4   6 , Adriano Gonçalves E Silva  4   7 , Ana Paula Garcia Cardoso  4   8 , André Deeke Sasse  4   9 , André P Fay  4   10 , André Paternò Castello Dias Carneiro  4   8   11 , Antonio Machado Alencar Junior  4   12   13   14 , Augusto César de Andrade Mota  4   15 , Bruno Santucci  4   16 , Daniel da Motta Girardi  4   5 , Daniel Herchenhorn  4   17 , Daniel Vilarim Araújo  4   18 , Denis Leonardo Jardim  4   19 , Diogo Assed Bastos  4   20 , Diogo Rodrigues Rosa  4   21 , Fabio A Schutz  4   22 , Fábio Roberto Kater  4   22 , Felipe da Silva Marinho  4   23 , Fernando Cotait Maluf  4   8   22 , Fernando Nunes Galvão de Oliveira  4   24 , Fernando Vidigal  4   13 , Igor Alexandre Protzner Morbeck  4   25 , Jose Augusto Rinck Júnior  4   26 , Leonardo Atem G A Costa  4   6 , Manuel Caitano Dias Ferreira Maia  4   27 , Manuela Zereu  4   28 , Marcelo Roberto Pereira Freitas  4   29 , Mariane Sousa Fontes Dias  4   21 , Milena Shizue Tariki  4   26 , Pamela Muniz  4   19   30 , Patrícia Medeiros Milhomem Beato  4   31 , Paulo Sérgio Moraes Lages  4   25 , Pedro Isaacsson Velho  4   32   33 , Ricardo Saraiva de Carvalho  4   22 , Rodrigo Coutinho Mariano  4   22 , Sandro Roberto de Araújo Cavallero  4   34 , Thiago Martins Oliveira  4   35 , Vinicius Carrera Souza  4   36 , Oren Smaletz  4   8 , Stênio de Cássio Zequi  26   37
Affiliations
Review

Advanced renal cell carcinoma management: the Latin American Cooperative Oncology Group (LACOG) and the Latin American Renal Cancer Group (LARCG) consensus update

Andrey Soares et al. J Cancer Res Clin Oncol. .

Abstract

Purpose: Renal cell carcinoma is an aggressive disease with a high mortality rate. Management has drastically changed with the new era of immunotherapy, and novel strategies are being developed; however, identifying systemic treatments is still challenging. This paper presents an update of the expert panel consensus from the Latin American Cooperative Oncology Group and the Latin American Renal Cancer Group on advanced renal cell carcinoma management in Brazil.

Methods: A panel of 34 oncologists and experts in renal cell carcinoma discussed and voted on the best options for managing advanced disease in Brazil, including systemic treatment of early and metastatic renal cell carcinoma as well as nonclear cell tumours. The results were compared with the literature and graded according to the level of evidence.

Results: Adjuvant treatments benefit patients with a high risk of recurrence after surgery, and the agents used are pembrolizumab and sunitinib, with a preference for pembrolizumab. Neoadjuvant treatment is exceptional, even in initially unresectable cases. First-line treatment is mainly based on tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs); the choice of treatment is based on the International Metastatic Database Consortium (IMCD) risk score. Patients at favourable risk receive ICIs in combination with TKIs. Patients classified as intermediate or poor risk receive ICIs, without preference for ICI + ICIs or ICI + TKIs. Data on nonclear cell renal cancer treatment are limited. Active surveillance has a place in treating favourable-risk patients. Either denosumab or zoledronic acid can be used for treating metastatic bone disease.

Conclusion: Immunotherapy and targeted therapy are the standards of care for advanced disease. The utilization and sequencing of these therapeutic agents hinge upon individual risk scores and responses to previous treatments. This consensus reflects a commitment to informed decision-making, drawn from professional expertise and evidence in the medical literature.

Keywords: Consensus; Immunotherapy; Metastatic disease; Renal cell carcinoma; Tyrosine kinase inhibitor; Vascular growth factor receptor.

PubMed Disclaimer

Conflict of interest statement

Andrey Soares: Honouraria—Janssen, Pfizer, Bayer, AstraZeneca, Astellas Pharma, Merck Serono, Sanofi, Ipsen, Adium; Consulting or Advisory Role—Astellas Pharma, Janssen, Bayer, AstraZeneca, MSD, Bristol-Myers Squibb, Adium, Ipsen, Pfizer; Research Funding—Bristol-Myers Squibb (Inst), Astellas (Inst), AstraZeneca (Inst); Travel, accommodation, and expenses—Bayer, Janssen, Ipsen, Adium, MSD, Merck Serono. Fernando Sabino Marques Monteiro: None. Karine Martins da Trindade: None. Adriano Gonçalves e Silva: None. Ana Paula Garcia Cardoso: Research funding—Eli Lily, Novartis, AstraZeneca, Astellas, Janssen, Bayer, Sanofi, Pfizer, BMS and MSD; Speaker—Bayer, MSD, Merck, Janssen, Sanofi, Novartis, Astelas, Vristol, Pfizer, Ipsen, AstraZeneca, and Zodiac. André Deeke Sasse: Speaker—Janssen, Bayer, Novartis, Astellas, Pfizer, Merck-Serono, MSD; Consulting—Roche; Advisory boards—Astellas, Janssen, Roche, Bayer, Astra Zeneca, Novartis, Pfizer, MSD, and Merck-Serono; Research support—BMS, Bayer. André P Fay: Honouraria—Pfizer, Astellas, BMS, Novartis, Roche, AstraZeneca, Janssen, MSD, Ipsen Scientific; Advisory Board—Janssen, Novartis, Roche, Ipsen, Pfizer, Bayer, MSD; Research Grants—CAPES—CNPq, BMS, Roche, AstraZeneca, MSD, Foundation Medicine, Ipsen; Ownership—BIO, Brazilian Information Oncology. André Paternò Castello Dias Carneiro: None. Antonio Machado Alencar Junior: None. Augusto César de Andrade Mota: None. Bruno Santucci: None. Daniel da Motta Girardi: None. Daniel Herchenhorn: None. Daniel Vilarim Araújo: Honouraria—Pfizer, MSD, Libbs, AstraZeneca, Novartis; Consulting or Advisory Role—MSD; Travel, Accommodations, Expenses—Pfizer. Denis Leonardo Jardim: Speaker—Janssen, Bayer, Ipsen, MSD, Astellas; Advisory Boards—Bayer, Astellas, Ipsen. Diogo Assed Bastos: Research Funding—Janssen, Astellas, Bayer; Honouraria—Janssen, Astellas, Bayer, MSD, BMS, AstraZeneca. Diogo Rodrigues Rosa: Speaker—Janssen, Pfizer, Astellas, AstraZeneca, MSD, Roche, Amgen, Dr. Reddys, BMS, Pfizer, Ipsen; Advisory Boards—Janssen, AstraZeneca, Bayer, Astellas, United Medical, MSD, BMS, Zodiac. Fabio A. Schutz: Honouraria—Bayer, Zodiac, Merck Sharp Dohme, Janssen, Astellas, Merck Serono. Fábio Roberto Kater: Speaker—AstraZeneca, Janssen, Astellas, Lilly, Bayer, MSD, BMS; Research funding—Roche, MSD. Advisory Board: AstraZeneca and Astellas; Events sponsorship—Daiichi, MSD, Roche. Felipe da Silva Marinho: None. Fernando Cotait Maluf: Research funding—Sanofi-aventis, Janssen, AstraZeneca, Roche, Astellas, MSD, BMS, Novartis; Speaker—Sanofi-aventis, Janssen, AstraZeneca, Roche, Astellas, MSD, BMS, Novartis, Amgen, Ferring; Advisory board—Sanofi-aventis, Janssen, AstraZeneca, Roche, Astellas, MSD, BMS, Novartis, Amgen, Ferring. Fernando Nunes Galvão de Oliveira: None. Fernando Sabino Marques Monteiro: None. Fernando Vidigal: Speaker— Astellas, Bayer, BMS, Janssen, MSD, Sanofi; Event sponsorship— Astellas, BMS, MSD, Janssen. Igor Alexandre Protzner Morbeck: Speaker—Bayer, Daichii, Roche, MSD, BMS, AstraZeneca; Steering committee—AstraZeneca. Jose Augusto Rinck Júnior: None. Leonardo Atem G. A. Costa: None. Manuel Caitano Dias Ferreira Maia: Speaker—Pfizer, Bayer, MSD, Astellas, BMS, Janssen, AstraZeneca, Novartis, Roche; Event sponsorship—Libbs, Astellas, BMS, Bayer, Roche, IPSEN, MSD, Novartis, and Libbs. Manuela Zereu: Honouraria—Janssen, Pfizer, Bayer, AstraZeneca, Ipsen, Adium; Consulting or Advisory Role—Janssen, Bayer, AstraZeneca. Travel, accommodation, and expenses—Bayer, Janssen, Ipsen, Adium, MSD. Marcelo Roberto Pereira Freitas: None. Mariane Sousa Fontes Dias: Honouraria—Janssen, Astellas, MSD Oncology, AstraZeneca, Amgen, Bayer, Zodiac, Ipsen, Merck; Consulting—Janssen, AstraZeneca, Ipsen, Merck, MSD Oncology; Speaker—Janssen Oncology, Astellas, MSD Oncology, Zodiac, Ipsen, AstraZeneca; Research funding—Janssen Research & Development, BMS, Bayer; Events sponsorship—AstraZeneca, Zodiac, Janssen Oncology, MSD Oncology. Milena Shizue Tariki: Speaker—MSD, BMS, Ipsen. Pamela Muniz: Speaker—Janssen, Bayer, AstraZeneca; Events sponsorship—Janssen, Bayer. Patrícia Medeiros Milhomem Beato: None. Paulo Sérgio Moraes Lages: Speaker—Astellas, Abayer, Janssen, MSD, BMS, Zodiac, Merck. Pedro Isaacsson Velho: None. Ricardo Saraiva de Carvalho: None. Rodrigo Coutinho Mariano: Research funding—Roche, BMS, MSD, Janssen, Ipsen; Speaker—AstraZeneca, Janssen, Bayer, Astellas, Ipsen, Zodiac, Pfizer, Merck; Event Sponsorships—Dr Reddys, Zodiac, Pfizer, Merck, Janssen, Daichii-Sanko. Sandro Roberto de Araújo Cavallero: None. Thiago Martins Oliveira: None. Vinicius Carrera Souza: Honouraria—Bayer, Janssen, Novartis, AstraZeneca, MSD; Zodiac Research Funding—Janssen Consultant: Janssen, Roche, AstraZeneca, Bayer, MSD. Oren Smaletz: Honouraria—MSD, BMS, Ipsen; Funding for the research—MSD, BMS; Consulting—BMS, Roche, Pfizer, Merck, Ipsen. Stênio de Cássio Zequi: Speaker—Bristol-Myers Squibb, Pfizer, AstraZeneca; Research funding—Merck Sharp & Dohme; Event sponsorships: Astellas.

References

    1. Abreu D, Carvalhal G, Gueglio G et al (2021) Prognostic factors in de novo metastatic renal cell carcinoma: a report from the Latin American renal cancer group. JCO Glob Oncol 7:671–685 - PMC - PubMed
    1. Albiges L, Gurney H, Atduev V et al (2023a) Pembrolizumab plus lenvatinib as first-line therapy for advanced non-clear-cell renal cell carcinoma (KEYNOTE-B61): a single-arm, multicentre, phase 2 trial. Lancet Oncol 11:881 - PubMed
    1. Albiges L, Powles T, Sharma A et al (2023b) CaboPoint: Interim results from a phase 2 study of cabozantinib after checkpoint inhibitor (CPI) therapy in patients with advanced renal cell carcinoma (RCC). J Clin Oncol 41(6):606
    1. Alhalabi O, Wilson N, Ajufo H et al (2022) 2022) Safety and differential clinical activity of nivolumab plus ipilimumab (nivo-ipi) in patients (pts) with non-clear cell renal cell carcinoma (nccRCC. J Clin Oncol 40:356
    1. Allaf M, Kim SE, Harshman LC et al (2022) Phase III randomized study comparing perioperative nivolumab (nivo) versus observation in patients (Pts) with renal cell carcinoma (RCC) undergoing nephrectomy (PROSPER, ECOG-ACRIN EA8143), a National Clinical Trials Network trial. Ann Oncol 33:S808–S869

LinkOut - more resources