ESMO issues treatment guidelines on renal cancer

  • Escudier B & al.
  • Ann Oncol
  • 1 May 2019

  • Oncology guidelines update
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Takeaway

  • European Society for Medical Oncology (ESMO) issues guidelines for the treatment of renal cell carcinoma (RCC).

Key recommendations

  • Local disease
    • T1 tumors (
    • T2 tumors (>7 cm): laparoscopic RN is the preferred treatment.
  • Locally advanced disease
    • T3 and T4 tumors: perform open RN; laparoscopic RN can be considered.
  • Advanced and metastatic RCC (mRCC)
    • Perform cytoreductive nephrectomy in patients with good performance status except in intermediate-/poor-risk patients with asymptomatic primary tumors.
    • Offer RT in unresectable disease and in patients unsuitable for surgery.
    • Consider palliative RT to prevent progression in critical sites.
    • mRCC with brain metastases: consider corticosteroids for temporary relief of cerebral symptoms, consider whole-brain radiotherapy (WBRT; 20/30 Gy in 4-10 fractions) for effective symptom control.
    • Consider stereotactic radiosurgery±WBRT for good-prognosis patients with single unresectable brain metastasis.
    • Good-/intermediate-risk group: offer vascular endothelial growth factor-targeted agents and tyrosine kinase inhibitor (TKIs) as first-line systemic treatment; tivozanib can also be considered.
    • Intermediate-/poor-risk group: nivolumab+ipilimumab is recommended; cabozantinib can also be considered.
    • Consider nivolumab/cabozantinib for second-line treatment after TKIs and in patients previously treated with 2 TKIs.
    • Consider lenvatinib+everolimus after TKIs.