Abstract：
OBJECTIVE: To provide recommendations for the management of patients with metastatic clear cell renal cell carcinoma (ccRCC).
METHODS: An Expert Panel conducted a systematic literature review to obtain evidence to guide treatment recommendations.
RESULTS: The panel considered peer-reviewed reports published in English.
CONCLUSIONS: The 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.Additional information is available at www.asco.org/genitourinary-cancer-guidelines.
METHODS: An Expert Panel conducted a systematic literature review to obtain evidence to guide treatment recommendations.
RESULTS: The panel considered peer-reviewed reports published in English.
CONCLUSIONS: The 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.Additional information is available at www.asco.org/genitourinary-cancer-guidelines.
摘要：
目的：为转移性肾透明细胞癌（ccRCC）的治疗提供建议。
方法：专家小组进行了系统的文献综述，以获取指导治疗建议的证据。
结果：专家组审议了以英文发表的同行评审报告。
结论：转移性ccRCC的诊断应使用原发肿瘤或转移部位的组织活检，并包括标记和/或染色以支持诊断。应使用国际转移性RCC数据库联盟风险标准来告知治疗。可以提供细胞减灭性肾切除术来选择患有原位肾脏和高危或中危疾病的患者。对于那些已经做了肾切除术的人来说，如果他们无症状且疾病负担低，则可以提供初始阶段的主动监测。需要全身治疗的高危疾病患者可接受免疫检查点抑制剂（ICI）与血管内皮生长因子受体（VEGFR）酪氨酸激酶抑制剂（TKI）的联合治疗；中危或低危患者应接受双重治疗方案（ICI或ICI与VEGFRTKI联合治疗未提供建议）。对于精选的患者，可以根据合并症提供ICI或VEGFRTKI的单药治疗.白细胞介素-2仍然是一种选择,尽管无法确定选择标准。还提供了二线和后续治疗以及骨转移治疗的建议，脑转移瘤,或存在肉瘤样特征。高度鼓励转移性ccRCC患者参与临床试验。其他信息可在www上获得。asco.org/泌尿生殖系统癌症指南。
方法：专家小组进行了系统的文献综述，以获取指导治疗建议的证据。
结果：专家组审议了以英文发表的同行评审报告。
结论：转移性ccRCC的诊断应使用原发肿瘤或转移部位的组织活检，并包括标记和/或染色以支持诊断。应使用国际转移性RCC数据库联盟风险标准来告知治疗。可以提供细胞减灭性肾切除术来选择患有原位肾脏和高危或中危疾病的患者。对于那些已经做了肾切除术的人来说，如果他们无症状且疾病负担低，则可以提供初始阶段的主动监测。需要全身治疗的高危疾病患者可接受免疫检查点抑制剂（ICI）与血管内皮生长因子受体（VEGFR）酪氨酸激酶抑制剂（TKI）的联合治疗；中危或低危患者应接受双重治疗方案（ICI或ICI与VEGFRTKI联合治疗未提供建议）。对于精选的患者，可以根据合并症提供ICI或VEGFRTKI的单药治疗.白细胞介素-2仍然是一种选择,尽管无法确定选择标准。还提供了二线和后续治疗以及骨转移治疗的建议，脑转移瘤,或存在肉瘤样特征。高度鼓励转移性ccRCC患者参与临床试验。其他信息可在www上获得。asco.org/泌尿生殖系统癌症指南。
