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NCCN Guidelines for Patients



Kidney Cancer, Version 1.2017


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


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


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)


• Best supportve care