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NCCN Flash Updates: NCCN Guidelines Updated for Kidney Cancer

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®), the NCCN Drugs and Biologics Compendium (NCCN Compendium^®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™) for Kidney Cancer. These NCCN Guidelines^® are currently available as Version 1.2023.

Link directly to the Updates section of the NCCN Guidelines: Kidney Cancer

KID-1

• Initial workup
  • Bullet 5 revised: CT chest (preferred) or chest x-ray.
  • Sub-bullet removed: Chest CT
• Adjuvant Treatment
  • Pathway 2 revised: "Clinical trial" removed.
  • Bottom pathway
    • Clear cell histology revised: "Clinical trial (preferred)" removed.
    • Non-clear cell histology revised: Surveillance or clinical trial

KID-3

• Treatment for Relapse or Stage IV
  • Clear cell histology
    • 4th line revised: "...Metastasectomy or SBRT or ablative techniques for oligometastatic disease or Metastasectomy with complete resection of disease, followed by adjuvant pembrolizumab within 1 year of nephrectomy."
• Disease Progression for Relapse or Stage IV
  • Clear cell histology
    • Bottom line added: "...Best supportive care or Metastasectomy or SBRT or ablative techniques for oligometastatic disease." (Also for Non-clear cell histology)

KID-A

• Principles of Surgery
  • Bullet 6, sub-bullet 3 revised: Ablative techniques are associated with a higher local recurrence rate than conventional surgery and may require multiple treatments to achieve the same local oncologic outcomes as conventional surgery

KID-C (1 of 2)

• Principles of Systemic Therapy for Relapse or Stage IV Disease
  • Subsequent Therapy for Clear Cell Histology
    • Preferred Regimens
      • Lenvatinib + everolimus was changed to a category 2A recommendation.
    • Other Recommended Regimens
      • Tivozanib was changed to a category 1 recommendation.
    • Useful in Certain Circumstances
      • Belzutifan was added as a category 2B recommendation.

KID-C (2 of 2)

• Systemic Therapy for Non-Clear Cell Histology
  • Other Recommended Regimens
    • Nivolumab + cabozantinib was added as a category 2A recommendation.
  • Useful in Certain Circumstances
    • Nivolumab + ipilimumab was added as a category 2B recommendation.
• Footnote h revised: 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. Gemcitabine + doxorubicin can also produce responses in renal medullary carcinoma (RMC) (Wilson NR, et al. Clin Genitourin Cancer 2021;(6) 19:e401-e408 Roubaud G, et al. Oncology 2011;80:214-218; Shah AY, et al. BJU Int 2017;120:782-792). Oral targeted therapies generally do not produce responses in patients with renal medullary carcinoma (RMC); erlotinib + bevacizumab can produce responses even in heavily pretreated patients with RMC. Outside of clinical trials, platinum-based chemotherapy regimens should be the preferred first-line therapy for renal medullary carcinoma RMC.

HRCC-1

• Criteria for Further Genetic Risk Evaluation for Hereditary RCC Syndromes
  • Bullet 2 revised: An individual with RCC or an individual unaffected with any of the following criteria
  • Column 2, bottom pathway revised: "...Refer to specific syndromes - See Hereditary RCC Syndromes Overview (HRCC-2), See NCCN Guidelines for Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic: Principles of Cancer Risk Assessment and Counseling (EVAL-A) and Pedigree (EVAL-B)"
• Footnotes
  • Footnote c added: If unaffected, when possible, test family member with highest likelihood of a pathogenic/likely pathogenic variant before testing an unaffected individual.
  • Footnote d added: Unnecessary in translocational RCC or medullary RCC.

HRCC-D

• Footnote 4 added: Belzutifan is FDA-approved for the treatment of VHL-associated RCC, central nervous system (CNS) hemangioblastomas, or pNET not requiring immediate surgery.
• Footnote 5 added: Jonasch E, Donskov F, Iliopoulos O, et al. Belzutifan for Renal Cell Carcinoma in von Hippel–Lindau Disease. N Engl J Med 2021;385:2036-2046.

ABBR-1

• New section added: Abbreviations

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 devices are now available! Visit NCCN.org/apps.

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