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Abstract：
OBJECTIVE: Renal cell carcinoma is an aggressive disease with a high mortality rate. Management has drastically changed with the new era of immunotherapy, and novel strategies are being developed; however, identifying systemic treatments is still challenging. This paper presents an update of the expert panel consensus from the Latin American Cooperative Oncology Group and the Latin American Renal Cancer Group on advanced renal cell carcinoma management in Brazil.
METHODS: A panel of 34 oncologists and experts in renal cell carcinoma discussed and voted on the best options for managing advanced disease in Brazil, including systemic treatment of early and metastatic renal cell carcinoma as well as nonclear cell tumours. The results were compared with the literature and graded according to the level of evidence.
RESULTS: Adjuvant treatments benefit patients with a high risk of recurrence after surgery, and the agents used are pembrolizumab and sunitinib, with a preference for pembrolizumab. Neoadjuvant treatment is exceptional, even in initially unresectable cases. First-line treatment is mainly based on tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs); the choice of treatment is based on the International Metastatic Database Consortium (IMCD) risk score. Patients at favourable risk receive ICIs in combination with TKIs. Patients classified as intermediate or poor risk receive ICIs, without preference for ICI + ICIs or ICI + TKIs. Data on nonclear cell renal cancer treatment are limited. Active surveillance has a place in treating favourable-risk patients. Either denosumab or zoledronic acid can be used for treating metastatic bone disease.
CONCLUSIONS: Immunotherapy and targeted therapy are the standards of care for advanced disease. The utilization and sequencing of these therapeutic agents hinge upon individual risk scores and responses to previous treatments. This consensus reflects a commitment to informed decision-making, drawn from professional expertise and evidence in the medical literature.
METHODS: A panel of 34 oncologists and experts in renal cell carcinoma discussed and voted on the best options for managing advanced disease in Brazil, including systemic treatment of early and metastatic renal cell carcinoma as well as nonclear cell tumours. The results were compared with the literature and graded according to the level of evidence.
RESULTS: Adjuvant treatments benefit patients with a high risk of recurrence after surgery, and the agents used are pembrolizumab and sunitinib, with a preference for pembrolizumab. Neoadjuvant treatment is exceptional, even in initially unresectable cases. First-line treatment is mainly based on tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs); the choice of treatment is based on the International Metastatic Database Consortium (IMCD) risk score. Patients at favourable risk receive ICIs in combination with TKIs. Patients classified as intermediate or poor risk receive ICIs, without preference for ICI + ICIs or ICI + TKIs. Data on nonclear cell renal cancer treatment are limited. Active surveillance has a place in treating favourable-risk patients. Either denosumab or zoledronic acid can be used for treating metastatic bone disease.
CONCLUSIONS: Immunotherapy and targeted therapy are the standards of care for advanced disease. The utilization and sequencing of these therapeutic agents hinge upon individual risk scores and responses to previous treatments. This consensus reflects a commitment to informed decision-making, drawn from professional expertise and evidence in the medical literature.
摘要：
目的：肾细胞癌是一种侵袭性疾病，死亡率高。随着免疫疗法的新时代，管理发生了巨大变化，新的策略正在开发中；然而，确定系统治疗仍然具有挑战性。本文介绍了拉丁美洲合作肿瘤学小组和拉丁美洲肾癌小组关于巴西晚期肾细胞癌管理的专家小组共识的更新。
方法：由34名肿瘤学家和肾癌专家组成的小组讨论并投票确定了处理巴西晚期疾病的最佳选择。包括早期和转移性肾细胞癌以及非透明细胞肿瘤的全身治疗。将结果与文献进行比较，并根据证据水平进行分级。
结果：辅助治疗有利于手术后复发风险高的患者，使用的药物是派博利珠单抗和舒尼替尼，与pembrolizumab的偏好。新辅助治疗是特殊的，即使在最初无法切除的病例中。一线治疗主要基于酪氨酸激酶抑制剂（TKIs）和免疫检查点抑制剂（ICIs）；治疗的选择基于国际转移数据库联盟（IMCD）风险评分。处于有利风险的患者接受ICIs与TKIs的组合。分类为中度或低度风险的患者接受ICIs，不偏好ICI+ICIs或ICI+TKIs。关于非透明细胞肾癌治疗的数据有限。主动监测在治疗有利风险患者方面有一席之地。地诺单抗或唑来膦酸均可用于治疗转移性骨病。
结论：免疫治疗和靶向治疗是治疗晚期疾病的标准。这些治疗剂的利用和排序取决于个体风险评分和对先前治疗的反应。这一共识反映了对知情决策的承诺，来自医学文献中的专业知识和证据。
方法：由34名肿瘤学家和肾癌专家组成的小组讨论并投票确定了处理巴西晚期疾病的最佳选择。包括早期和转移性肾细胞癌以及非透明细胞肿瘤的全身治疗。将结果与文献进行比较，并根据证据水平进行分级。
结果：辅助治疗有利于手术后复发风险高的患者，使用的药物是派博利珠单抗和舒尼替尼，与pembrolizumab的偏好。新辅助治疗是特殊的，即使在最初无法切除的病例中。一线治疗主要基于酪氨酸激酶抑制剂（TKIs）和免疫检查点抑制剂（ICIs）；治疗的选择基于国际转移数据库联盟（IMCD）风险评分。处于有利风险的患者接受ICIs与TKIs的组合。分类为中度或低度风险的患者接受ICIs，不偏好ICI+ICIs或ICI+TKIs。关于非透明细胞肾癌治疗的数据有限。主动监测在治疗有利风险患者方面有一席之地。地诺单抗或唑来膦酸均可用于治疗转移性骨病。
结论：免疫治疗和靶向治疗是治疗晚期疾病的标准。这些治疗剂的利用和排序取决于个体风险评分和对先前治疗的反应。这一共识反映了对知情决策的承诺，来自医学文献中的专业知识和证据。
