

56
NCCN Guidelines for Patients
®
:
Kidney Cancer, Version 1.2017
5
Treatment guide
Stage IV and relapsed kidney cancer
Guide 10
shows the next treatments that are
recommended for clear cell RCC that grew during
or after first-line treatment. Which treatment is
recommended next depends on the type of drug you
received as first-line treatment. This is because some
drugs may work better when taken after certain other
drugs.
Your doctor will consider the options for your next
therapy. The first option is to receive treatment within
a clinical trial. A clinical trial is a type of research that
studies how safe and helpful a treatment is.
Cabozantinib and nivolumab are the preferred
systemic treatment options. Other options include
one of the following therapy drugs: axitinib,
bevacizumab, lenvatinib, everolimus, pazopanib,
sorafenib, sunitinib, or temsirolimus. Each therapy
drug works in a slightly different way and can cause
side effects. Each of these drugs may be a good
option for different reasons. It is important to weigh
the risks and benefits of each drug to choose the
best option for you.
The next option is high-dose IL-2, a type cytokine
therapy (also called immunotherapy). 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.
Supportive care is recommended along with
cancer treatment for all patients. Supportive care is
treatment given to relieve the symptoms of cancer or
side effects of cancer treatment. It aims to improve
quality of life and relieve any discomfort you may
have.
Supportive care may include radiation therapy,
surgery, drugs, or other treatments. Radiation
therapy may be used to relieve pain from cancer
that has spread to your bones or brain. Drugs that
strengthen your bones may also help with pain
and other problems caused by bone metastases.
Surgery to remove metastases may also be used to
ease symptoms. See page 39
for more details about
supportive care.
Guide 10. Treatment after first-line
for clear cell RCC
Clear cell RCC next treatment options
• Clinical trial
• Cabozanitinib
• Nivolumab
• Axitinib
• Levatinib + everolimus
• Everolimus
• Pazopanib
• Sorafenib
• Sunitinib
• Bevacizumab
• High-dose IL-2 (for certain patients)
• Temsirolimus (for certain patients)
and
• Best supportve care