NCCN Guidelines for Patients
Kidney Cancer, Version 1.2017
More research is needed to find the best treatment
options for non-clear cell RCC. Thus, treatment on
a clinical trial is the preferred option for patients with
non-clear cell RCC.
For clear cell RCC,
there are several treatment
options to choose from besides a clinical trial. Most
of the options are types of targeted therapy. Sunitinib,
pazopanib, axitinib, and sorafenib are a type of
targeted therapy called TKIs. They block signals in
cells that help kidney cancer grow and spread. Each
TKI works in a slightly different way and can cause
side effects. Each drug may be a good option for
different reasons. Pazopanib and sunitinib are the
preferred option for this stage of disease. Your doctor
will weigh the risks and benefits of each drug to
choose the best option for you.
Another option is to receive bevacizumab and
interferon alfa. Bevacizumab is a type of targeted
therapy called an angiogenesis inhibitor. Interferon
alfa is a type of cytokine therapy (also called
immunotherapy). Interferon alfa works better
against kidney cancer when it’s given along with
bevacizumab. But, each drug has side effects and
they may be more severe when both drugs are given.
Temsirolimus is a type of targeted therapy called an
mTOR inhibitor. It may be a good option for certain
patients, such as those with three or more poor risk
factors. A poor risk factor is something that increases
the risk that cancer will be aggressive and progress
quickly. Poor risk factors include having trouble with
daily activities or work, metastases in two or more
organs, too much calcium in the blood, and starting
drug treatment less than one year after diagnosis.
High-dose IL-2 is another type of cytokine therapy
that may be an option for some patients. Due to the
risk of severe side effects, high-dose IL-2 is not a
good option for everyone.
It is only recommended if your overall health is good,
your organs are working well, and you are able to do
normal daily activities well.
For those patients with clear cell RCC that has
sarcomatoid features a combination of drugs may be
considered. This includes chemotherapy drugs such
as gemcitabine and doxorubicin given together or
gemcitabine with sunitinib.
For non-clear cell RCC
, there are also several
treatment options to choose from. Many of the
options are the same as those recommended
for clear cell RCC. A clinical trial is the preferred
treatment option for non-clear cell RCC. Other
options include kinase inhibitors such as sunitinib
(preferred), axitinib, cabozantinib, pazopanib, and
Bevacizumab, an angiogenesis inhibitor, and
nivolumab, a monoclonal antibody, may also be
offered. Erlotinib, lenvatinib, everolimus, and
temsirolimus are other recommended options.
Erlotinib is an EGFR inhibitor. Lenvatinib is a kinase
inhibitor and is given with everolimus. Everolimus
and temsirolimus are mTOR inhibitors. mTOR
inhibitors and EGFR inhibitors work in slightly
different ways to block the signals that tell cancer
cells to grow.
Chemotherapy drugs may also be an option for
very rare types of non-clear cell RCC known as
collecting duct and medullary. The combination
of chemotherapy drugs may include carboplatin
with gemcitabine or paclitaxel, or cisplatin with
For those patients with non-clear cell and clear cell
RCC that has sarcomatoid features a combination
of drugs may be considered. This includes the
chemotherapy drugs gemcitabine and doxorubicin
given together or gemcitabine with sunitinib.
Stage IV and relapsed kidney cancer