14.
Strategy for metastatic or unresectable clear-cell RCC therapy (clinical trial preferred in any of the following situations)
| Treatment status | Stratification | Level I
recommendation |
Level II
recommendation |
Level III
recommendation |
| RCC, renal cell cancer. | ||||
| First-line
treatment |
Low and
medium risk |
Sunitinib (1A evidence)
Pazopanib (1A evidence) Sorafenib (2A evidence) |
Axitinib (2A evidence)
Cabozantinib (2A evidence) bevacizumab + IFN (1A vidence) IFN-α (2A evidence) Large dose of IL-2 (2A evidence) |
|
| High risk | Clinical trial | Temsirolimus (1A evidence)
Cabozantinib (2A evidence) Sunitinib (2A evidence) |
Pazopanib
Sorafenib Axitinib |
|
| Second-
line treatment |
TKI failed | Axitinib (1A evidence)
Everolimus (1A evidence) |
Cabozantinib (1A evidence)
Nivolumab (1A evidence) Lenvatinib + everolimus (2A evidence) sorafenib (2A evidence) Sunitinib (2A evidence) |
Pazopanib
Sorafenib + bevacizumab |
| Cytokine
failure |
Axitinib (1B evidence)
Sorafenib (1A evidence) Sunitinib (1B evidence) Pazopanib (1B evidence) |
Clinical trial | Cabozantinib
Lenvatinib + everolimus |
|
| Third-
line treatment |
Clinical trial | Sorafenib (2A evidence)
Everolimus (2A evidence) Nivolumab (2A evidence) Cabozantinib (2A evidence) |
sorafenib +
bevacizum |
|