Management of Metastatic Clear Cell Renal Cell Carcinoma: ASCO Guideline

W. Kimryn Rathmell, R. Bryan Rumble, Peter J. Van Veldhuizen, Hikmat Al-Ahmadie, Hamid Emamekhoo, Ralph J. Hauke, Alexander V. Louie, Matthew I. Milowsky, Ana M. Molina, Tracy L. Rose, Shankar Siva, Nicholas G. Zaorsky, Tian Zhang, Rubina Qamar, Terry M. Kungel, Bryan Lewis, Eric A. Singer

Research output: Contribution to journalArticlepeer-review

58 Scopus citations


PURPOSETo provide recommendations for the management of patients with metastatic clear cell renal cell carcinoma (ccRCC).METHODSAn Expert Panel conducted a systematic literature review to obtain evidence to guide treatment recommendations.RESULTSThe panel considered peer-reviewed reports published in English.RECOMMENDATIONSThe diagnosis of metastatic ccRCC should be made using tissue biopsy of the primary tumor or a metastatic site with the inclusion of markers and/or stains to support the diagnosis. The International Metastatic RCC Database Consortium risk criteria should be used to inform treatment. Cytoreductive nephrectomy may be offered to select patients with kidney-in-place and favorable- or intermediate-risk disease. For those who have already had a nephrectomy, an initial period of active surveillance may be offered if they are asymptomatic with a low burden of disease. Patients with favorable-risk disease who need systemic therapy may be offered an immune checkpoint inhibitor (ICI) in combination with a vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor (TKI); patients with intermediate or poor risk should be offered a doublet regimen (no recommendation was provided between ICIs or an ICI in combination with a VEGFR TKI). For select patients, monotherapy with either an ICI or a VEGFR TKI may be offered on the basis of comorbidities. Interleukin-2 remains an option, although selection criteria could not be identified. Recommendations are also provided for second- and subsequent-line therapy as well as the treatment of bone metastases, brain metastases, or the presence of sarcomatoid features. Participation in clinical trials is highly encouraged for patients with metastatic ccRCC.

Original languageEnglish (US)
Article number00868
JournalJournal of Clinical Oncology
StatePublished - May 1 2022
Externally publishedYes

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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