From the Guidelines
Treatment Options for Oligoprogressive Renal Cell Carcinoma (RCC)
For patients with oligoprogressive renal cell carcinoma (RCC), continuation of systemic therapy with adjustments to target the progressing lesion is a viable option, which may include adding local therapy like stereotactic body radiation therapy (SBRT) with doses ranging from 24-30 Gy in 3-5 fractions 1.
- Alternatively, switching to a different systemic therapy, such as nivolumab 240 mg every 2 weeks or cabozantinib 60 mg daily, may be considered 1.
- Local ablative therapies, including radiofrequency ablation (RFA) or cryoablation, can also be employed to control the progressing lesion while maintaining systemic therapy.
- Metastasectomy remains an appropriate local treatment for most metastatic sites, especially when margin-free, and can provide a benefit in terms of overall survival (OS), cancer-specific survival (CSS), and delay of systemic therapy 1.
- Radiotherapy, especially stereotactic radiotherapy, to bone and brain metastases from RCC can provide significant relief from local symptoms 1.
- For patients with oligometastatic disease recurrence, observation for up to a median of 15 months until initiation of systemic therapy is a common practice in real-world settings, with careful reassessment of disease status to rule out rapid progression 1.