Abstract：
BACKGROUND: Second-line systemic treatment options for metastatic clear cell renal cell cancer (mccRCC) are diverse and treatment strategies are variable among experts. Our aim was to investigate the approach for the second-line treatment after first-line therapy with a tyrosine kinase inhibitor (TKI). Recently two phase III trials have demonstrated a potential role for nivolumab (NIV) and cabozantinib (CAB) in this setting. We aimed to estimate the impact of these trials on clinical decision making.
METHODS: Eleven international experts were asked to provide their treatment strategies for second-line systemic therapy for mccRCC in the current setting and once NIV and CAB will be approved and available. The treatment strategies were analyzed with the objective consensus approach.
RESULTS: The analysis of the decision trees revealed everolimus (EVE), axitinib (AXI), NIV and TKI switch (sTKI) as therapeutic options after first-line TKI therapy in the current situation and mostly NIV and CAB in the future setting. The most commonly used criteria for treatment decisions were duration of response, TKI tolerance and zugzwang a composite of several related criteria.
CONCLUSIONS: In contrast to the first-line setting, recommendations for second-line systemic treatment of mccRCC among experts were not as heterogeneous. The agents mostly used after disease progression on a first-line TKI included: EVE, AXI, NIV and sTKI. In the future setting of NIV and CAB availability, NIV was the most commonly chosen drug, whereas several experts identified situations where CAB would be preferred.
METHODS: Eleven international experts were asked to provide their treatment strategies for second-line systemic therapy for mccRCC in the current setting and once NIV and CAB will be approved and available. The treatment strategies were analyzed with the objective consensus approach.
RESULTS: The analysis of the decision trees revealed everolimus (EVE), axitinib (AXI), NIV and TKI switch (sTKI) as therapeutic options after first-line TKI therapy in the current situation and mostly NIV and CAB in the future setting. The most commonly used criteria for treatment decisions were duration of response, TKI tolerance and zugzwang a composite of several related criteria.
CONCLUSIONS: In contrast to the first-line setting, recommendations for second-line systemic treatment of mccRCC among experts were not as heterogeneous. The agents mostly used after disease progression on a first-line TKI included: EVE, AXI, NIV and sTKI. In the future setting of NIV and CAB availability, NIV was the most commonly chosen drug, whereas several experts identified situations where CAB would be preferred.
摘要：
背景：转移性透明细胞肾细胞癌（mccRCC）的二线系统治疗方案多种多样，专家的治疗策略也各不相同。我们的目的是研究酪氨酸激酶抑制剂（TKI）一线治疗后的二线治疗方法。最近，两项III期试验证明了纳武单抗（NIV）和卡博替尼（CAB）在这种情况下的潜在作用。我们旨在评估这些试验对临床决策的影响。
方法：11位国际专家被要求在目前的情况下提供他们对mccRCC二线系统治疗的治疗策略，一旦NIV和CAB被批准并可用。采用客观共识方法对治疗策略进行分析。
结果：对决策树的分析显示依维莫司（EVE），阿西替尼（AXI），NIV和TKI转换（sTKI）在目前情况下作为一线TKI治疗后的治疗选择，在未来情况下主要是NIV和CAB。最常用的治疗决策标准是反应持续时间，TKI耐受性和zugzwang几个相关标准的综合。
结论：与第一行设置相反，专家对mccRCC二线系统治疗的建议没有那么不同.在一线TKI上疾病进展后主要使用的药物包括：EVE，AXI,NIV和sTKI。在NIV和CAB可用性的未来设置中，NIV是最常用的药物,而几位专家确定了首选CAB的情况。
方法：11位国际专家被要求在目前的情况下提供他们对mccRCC二线系统治疗的治疗策略，一旦NIV和CAB被批准并可用。采用客观共识方法对治疗策略进行分析。
结果：对决策树的分析显示依维莫司（EVE），阿西替尼（AXI），NIV和TKI转换（sTKI）在目前情况下作为一线TKI治疗后的治疗选择，在未来情况下主要是NIV和CAB。最常用的治疗决策标准是反应持续时间，TKI耐受性和zugzwang几个相关标准的综合。
结论：与第一行设置相反，专家对mccRCC二线系统治疗的建议没有那么不同.在一线TKI上疾病进展后主要使用的药物包括：EVE，AXI,NIV和sTKI。在NIV和CAB可用性的未来设置中，NIV是最常用的药物,而几位专家确定了首选CAB的情况。
