eBulletin Newsletter

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


  • 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


  • 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)


  • 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.


  • 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.


  • 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.


  • 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.

About NCCN Flash Updates™

NCCN Flash Updates™ is a subscription service from NCCN that provides timely notification of updated and new information appearing in the NCCN Guidelines, the NCCN Compendium®, and other NCCN Content.

Subscribe to NCCN Flash Updates™

Please note: 1. Third Party Content. The NCCN Content may contain content (such as figures, tables or illustrations) that NCCN licenses from third parties as displayed on NCCN Third Party Content FTP site: ftp://ftp1.nccn.org (To access: user name:content; password is NCCNcontent) (“Third Party Content”). Licensee shall be solely responsible for obtaining permissions from each such third party to use any such Third Party Content in the Permitted Works.

Access information on permissions and licensing of NCCN Content

Users may unsubscribe from Flash Updates at any time by contacting us. NOTE: The subscription fee for NCCN Flash Updates™ is non-refundable.