What are the treatment options for Renal Cell Carcinoma (RCC)?

From the Guidelines

For localized Renal Cell Carcinoma (RCC), partial nephrectomy (PN) is the preferred treatment option over radical nephrectomy (RN) due to better preservation of kidney function and lower risk of developing metabolic or cardiovascular disorders, as supported by the European Association of Urology guidelines update in 2022 1.

Treatment Options for RCC

The treatment of RCC depends on the stage and individual patient factors. For localized RCC, surgical approaches are primary, including:

• Partial nephrectomy (PN) for localized T1 RCCs, which is associated with better preservation of kidney function and lower risk of metabolic or cardiovascular disorders 1
• Radical nephrectomy (RN) may be considered in certain cases, but PN is generally preferred for its benefits in preserving kidney function
• Minimally invasive techniques like laparoscopic or robotic surgery are often used
• Ablative therapies such as radiofrequency ablation or cryotherapy may be options for small tumors in patients who cannot undergo surgery

Systemic Therapies for Advanced or Metastatic RCC

For advanced or metastatic RCC, systemic therapies are the mainstay, including:

• Targeted therapies (sunitinib, pazopanib, cabozantinib, axitinib)
• Immunotherapies (nivolumab, pembrolizumab, ipilimumab)
• Combination approaches, such as nivolumab plus ipilimumab or pembrolizumab plus axitinib as first-line treatments
• Cytoreductive nephrectomy may benefit selected patients, but its use has been reevaluated in recent guidelines, suggesting that systemic therapy should be the primary approach for patients with intermediate- and poor-risk metastatic renal clear cell carcinoma 1

Active Surveillance and Follow-up

Active surveillance might be appropriate for small, incidentally discovered tumors in elderly patients or those with significant comorbidities. Treatment selection considers tumor characteristics, patient performance status, comorbidities, and potential side effects of therapy. The American College of Radiology has provided updated guidelines on the appropriate use of imaging examinations for asymptomatic patients who have been treated for RCC or are undergoing active surveillance 1.

From the FDA Drug Label

1.2 Advanced Renal Cell Carcinoma Sunitinib malate capsules are indicated for the treatment of adult patients with advanced renal cell carcinoma (RCC).

1.3 Adjuvant Treatment of Renal Cell Carcinoma Sunitinib malate capsules are indicated for the adjuvant treatment of adult patients at high risk of recurrent RCC following nephrectomy.

The treatment options for Renal Cell Carcinoma (RCC) include:

• Advanced RCC: Sunitinib malate capsules are indicated for the treatment of adult patients with advanced RCC.
• Adjuvant treatment of RCC: Sunitinib malate capsules are indicated for the adjuvant treatment of adult patients at high risk of recurrent RCC following nephrectomy.

The recommended dosage of sunitinib malate capsules for advanced RCC is 50 mg taken orally once daily, on a schedule of 4 weeks on treatment followed by 2 weeks off (Schedule 4/2) until disease progression or unacceptable toxicity 2. The recommended dosage of sunitinib malate capsules for the adjuvant treatment of RCC is 50 mg taken orally once daily, on a schedule of 4 weeks on treatment followed by 2 weeks off (Schedule 4/2), for nine 6-week cycles 2.

From the Research

Treatment Options for Renal Cell Carcinoma (RCC)

The treatment options for RCC depend on the stage and type of the disease.

• For early-stage RCC, treatment options include:
  • Surgical resection with partial or radical nephrectomy 3
  • Ablative techniques such as cryoablation, radiofrequency ablation, or radiation 3
  • Active surveillance for patients with small renal masses (<2 cm) 3
• For advanced or metastatic RCC, treatment options include:
  • Combinations of immune checkpoint inhibitors or the combination of immune checkpoint inhibitors with tyrosine kinase inhibitors 3, 4
  • Cabozantinib, which has shown promising results in patients with non-clear cell RCC, particularly those with papillary RCC 5, 6

Non-Clear Cell Renal Cell Carcinoma (nccRCC) Treatment

For patients with nccRCC, treatment options are limited. However, studies have shown that:

• Cabozantinib plus nivolumab can achieve a favorable objective response rate (ORR) in patients with nccRCC, including those with papillary, unclassified, or translocation-associated RCC 6
• Cabozantinib has shown efficacy in patients with metastatic nccRCC who have progressed on previous therapies 5

Prognostic Factors in RCC

Prognostic factors in RCC include:

• Anatomical factors such as TNM classification and tumor size 7
• Histological factors such as Fuhrman grade and histologic subtype 7
• Clinical factors such as symptoms and performance status 7
• Molecular features, although their predictive value is still being researched 7