The National Comprehensive Cancer Network (NCCN) recently issued an updated version of their guidelines for varying histologies of kidney cancer.
The guideline panel made changes to the stage IV kidney cancer algorithm, adding an option to the primary treatment for potentially surgically resectable primary tumor with oligometastatic sites. Along with nephrectomy plus surgical metastasectomy, the guidelines now recommend ablative techniques of metastases in selected patients who are not candidates for surgery.
The updated guidelines also feature new therapeutic options for both clear cell histology and non-clear cell histology kidney cancer. In predominant clear cell histology disease, multiple first-line therapies were added: cabozantinib for poor- and intermediate-risk groups, and active surveillance for select, asymptomatic patients. Sorafenib for selected patients was removed as a first-line options in this population of patients.
Additionally, a couple of changes were made to the section of the guidelines for non-clear cell histology kidney cancer. Two systemic therapies were added to the algorithm: bevacizumab plus erlotinib for selected patients with advanced papillary renal cell carcinoma including hereditary leiomyomatosis and renal cell carcinoma (category 2A designation), along with bevacizumab plus everolimus in the same group of patients (category 2A designation).
The guidelines further list the appropriate risk models to direct treatment for kidney cancer. The Memorial Sloan Kettering Cancer Center Prognostic Model and the International Metastatic Renal Cell Carcinoma Database Consortium Criteria were both added to the list of acceptable risk models.
The latest TNM Staging System for Kidney Cancer was added to the guidelines as well.—Zachary Bessette