Table 1.

Therapeutic options for advanced clear-cell RCC

Participation in clinical trials is strongly encouraged in all settings of treatment

Setting	Patients	Preferred	Options
Untreated	Favorable-risk (IMDC)	Pembrolizumab + Axitinib Nivolumab + Cabozantinib* Lenvatinib + Pembrolizumab*	Sunitinib Pazopanib Axitinib + Avelumab* Active surveillance
	Intermediate-/poor-risk (IMDC)	Ipilimumab + Nivolumab Pembrolizumab + Axitinib Nivolumab + Cabozantinib* Lenvatinib + Pembrolizumab*	Sunitinib Pazopanib Cabozantinib Axitinib + Avelumab* Active surveillance
Second-line and beyond	Prior VEGF inhibitor	Nivolumab Cabozantinib	Lenvatinib + Everolimus Axitinib Everolimus
	Options
	Prior immune checkpoint inhibitor	Axitinib Cabozantinib* Lenvatinib + Everolimus* Pazopanib Sunitinib
	Prior VEGF and immune checkpoint inhibitor#	Axitinib Cabozantinib Lenvatinib + Everolimus Pazopanib Sunitinib

“Preferred” options originated from studies that have demonstrated overall survival (OS) improvements. “Options” have usually demonstrated a progression-free survival advantage but not necessarily OS survival.

^*Not yet approved in Canada for this indication.

^#If not previously used.

IMDC: International Metastatic RCC Database Consortium; RCC: renal cell carcinoma; VEGF: vascular endothelial growth factor.