Renal cell carcinoma: updated ESMO guidelines


  • Dawn O'Shea
  • Univadis Medical News
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The European Society for Medical Oncology (ESMO) has published clinical practice guidelines for the diagnosis, treatment and follow-up of renal cell carcinoma (RCC). Key recommendations include:

Laboratory tests 

  • serum creatinine 
  • haemoglobin 
  • leukocyte and platelet counts 
  • lymphocyte:neutrophil ratio 
  • lactate dehydrogenase 
  • C-reactive protein
  • serum corrected calcium

Local/locoregional disease

  • Partial nephrectomy (PN) for organ confined T1 tumours
  • Radiofrequency-, microwave- or cryo-ablation for cortical tumours ≤3 cm.
  • Laparoscopic RN for T2 tumours >7 cm.
  • Open/laparoscopic RN for T3 and T4 tumours.

Advanced/metastatic disease

  • Cytoreductive nephrectomy (CN) for good performance status, except intermediate-/poor-risk asymptomatic primary tumours.
  • Radiotherapy (RT) for unresectable local or recurrent disease.
  • Corticosteroids for temporary relief of cerebral symptoms of brain metastasis. Whole-brain radiotherapy (WBRT) 20-30 Gy in 4-10 fractions for effective symptom control.
  • Stereotactic radiosurgery (SRS)±WBRT for good-prognosis metastatic renal cell carcinoma with single unresectable brain metastasis.
  • First-line systemic treatment for good-/intermediate-risk: VEGF-targeted agents and tyrosine kinase inhibitors (TKIs).
  • Tivozanib for good-risk patients.
  • Nivolumab+ipilimumab for intermediate/poor-risk patients. Cabozantinib now EMA approved.
  • Second-line treatment: nivolumab, cabozantinib or tivozanib after TKI. Lenvatinib+everolimus after nivolumab+ipilimumab. If none of these drugs is available, either everolimus or axitinib can be used.
  • Nivolumab or cabozantinib after two TKIs.