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NCCN Guidelines®, NCCN Compendium®, and NCCN Templates® for Kidney Cancer

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and the NCCN Drugs and Biologics Compendium (NCCN Compendium®) for Kidney Cancer. These NCCN Guidelines® are currently available as Version 1.2020.

  • Initial Workup (KID-1)
    • Bullet 8 was added: If multiple renal masses or <46 y, consider genetic evaluation.
    • Under Primary Treatment:
      • Stage I (T1a): Primary treatment options were listed in order of preference, then alphabetically
        • The phrase "in selected patients" was removed after "Ablative techniques" and "Active surveillance".
        • The phrase after Radical nephrectomy was revised: (if partial nephron-sparing not indicated or feasible or central location).
      • Stage I (T1b):
        • “Active surveillance (in select patients)” was added as a Primary treatment option.
      • Stage II was separated from Stage III
        • For Stage II, Primary treatment options were modified to match options in other stages: "Partial nephrectomy (if clinically indicated)” or "Radical nephrectomy"; Adjuvant treatment options include: "Clinical trial" or "Surveillance".
          • A regimen was removed: Adjuvant sunitinib (category 2B)
        • For Stage III, Adjuvant treatment options were separated into Clear cell and Non-clear cell histologies and modified:
          • Clear cell histology and high-risk: Clinical trial (preferred) or Surveillance or Adjuvant sunitinib (category 2B) (category 3).
          • All others Non-clear cell histology: Clinical trial or Surveillance
    • After Follow-up, "Relapse See KID-3" was revised to “Relapse or Progression, See KID-3”
    • A footnote was modified: "Biopsy of small lesions ... guide surveillance or ablative techniques, cryosurgery, and radiofrequency ablation strategies."
    •  A footnote was added to qualify "Surveillance": See Follow-up (KID-B)
    • Two footnotes were removed:
      • High-risk defined as: tumor stage 3 or higher, regional lymph-node metastasis, or both.
      • Dosing of adjuvant sunitinib: 50 mg per day - 4 weeks on, 2 weeks off for 1 year.
  • Primary Treatment (KID-2)
    • “Potentially surgically resectable primary with oligometastatic sites” was removed to eliminate redundant treatment options on KID-2 and KID-3
    • The first statement was modified: Potentially surgically resectable primary with multiple metastatic sites
    • A second statement was added: Consider tissue sampling
      • This pathway now leads to 2 options: Cytoreductive nephrectomy in select patients or Systemic therapy (See KID-3) (preferred in clear cell histology with poor-risk features)
    • A footnote was removed: No single follow-up plan is appropriate for all patients. Follow-up should be individualized based on patient requirements.
  • Treatment and Disease Progression for Clear cell and Non-clear cell histology (KID-3):
  • Under “Disease Progression”, three options were added for Non-clear cell histology:
  • Clinical trial
  • See Systemic Therapy for Non-Clear Cell Histology (KID-C, 2 of 2)
  • Best supportive care
  • KID-4 and KID-5 were changed to The Principles of Systemic Therapy for Relapse or Stage IV Disease and renamed KID-C, 1 of 2 and KID-C, 2 of 2.
  • Principles of Surgery (KID-A)
    • Bullet 4 was modified: If adrenal gland is uninvolved, resection adrenalectomy may be omitted.
    • Active surveillance:
      • A sub-bullet was added: Active surveillance of patients with T1a tumors (≤4 cm) that have a predominantly cystic component is recommended.
      • A sub-bullet was modified: "...demonstrate growth changes (eg, increasing tumor size, growth rate, infiltrative pattern)..."
  • Follow-Up (KID-B) was extensively revised.
  • Principles of Systemic Therapy for Relapse or Stage IV Disease: Clear Cell Histology (KID-C, 1 of 2)
    • First-line Therapy for Clear Cell Histology: Favorable risk, Other recommended regimens
      • Axitinib + avelumab was added as a category 2A recommendation.
    • First-line Therapy for Clear Cell Histology: Favorable risk, Useful under certain circumstances
      •  A regimen was removed: "Bevacizumab + interferon alfa-2b (category 1)"
    • First-line Therapy for Clear Cell Histology: Poor/intermediate risk, Other recommended regimens
      • Axitinib + avelumab was added as a category 2A recommendation.
      • Pazopanib changed from a category 1 recommendation to a category 2A recommendation.
      • Sunitinib changed from a category 1 recommendation to a category 2A recommendation.
    • First-line Therapy for Clear Cell Histology: Poor/intermediate risk, Useful under certain circumstances
      • A regimen was removed: Bevacizumab + interferon alfa-2b (category 1)
      • Temsirolimus changed from a category 1 recommendation to a category 2A recommendation.
        • A footnote was added (also added on KID-C, 2 of 2): The poor risk model used in the global ARCC trial to direct treatment with temsirolimus included at least 3 of the following 6 predictors of short survival: <1 year from the time of diagnosis to start of systemic therapy, Karnofsky performance status score 60–70, hemoglobin 1.5 times the ULN, and metastasis in multiple organs. Hudes G, Carducci M, Tomczak P, et al. Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med 2007;356:2271-2281.
    • Subsequent Therapy for Clear Cell Histology: Other recommended regimens
      • Axitinib + avelumab was added as a category 3 recommendation.
    • Subsequent Therapy for Clear Cell Histology: Useful under certain circumstances
      • A regimen was modified: Bevacizumab or biosimilar (category 2B) (also modified on KID-C, 2 of 2).
      • A footnote was added: Biosimilar options include: bevacizumab-awwb (also added on KID-C, 2 of 2).
    • Two footnotes were removed (also removed on KID-C, 2 of 2):
      • See Risk Models to Direct Treatment (Predictors of Short Survival Used to Select Patients for Temsirolimus) (KID-C).
      • In clear cell and non-clear cell RCC with predominant sarcomatoid features, gemcitabine + doxorubicin (category 2B) and gemcitabine + sunitinib (category 2B) have shown benefit.
  • Principles of Systemic Therapy for Relapse or Stage IV Disease: Non-clear Cell Histology (KID-C, 2 of 2)
    • A footnote was modified: For collecting duct or medullary subtypes, partial responses have been observed with cytotoxic chemotherapy (carboplatin + gemcitabine, carboplatin + paclitaxel, or cisplatin + gemcitabine) and other platinum-based chemotherapies currently used for urothelial carcinomas. Oral targeted therapies generally do not produce responses in patients with renal medullary carcinoma. Outside of clinical trials, platinum-based chemotherapy regimens should be the preferred therapy for renal medullary carcinoma.
  • Staging (ST-1)
    • Table 2, Stage III: "N0-N1" was modified to "NX,N0-N1"
    • Table 3: "Histologic Grade (G)" was added.

 

NCCN has published updates to the NCCN Chemotherapy Order Templates (NCCN Templates®) for Kidney Cancer to reflect the NCCN Guidelines for Kidney Cancer v1.2020.

The following NCCN Templates have been removed:

  • KDN4: DOXOrubicin/Gemcitabine
  • KDN14: Bevacizumab/Interferon alfa-2b
  • KDN23: Gemcitabine/SUNItinib

 

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Drugs & Biologics Compendium (NCCN Compendium®), the NCCN Biomarkers Compendium®, the NCCN Chemotherapy Order Templates (NCCN Templates®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org.

To view the NCCN Guidelines for Patients®, please visit NCCN.org/patientguidelines.

Free NCCN Guidelines apps for iPhone, iPad, and Android smartphones & tablets are now available! Visit NCCN.org/apps

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