First-Line Treatment for Advanced or Metastatic Clear-Cell RCC When Immune Checkpoint Inhibitors Are Contraindicated or Unavailable
Standard first-line management of advanced or metastatic clear-cell renal cell carcinoma frequently incorporates immune checkpoint inhibitor (ICI)-based regimens. However, a subset of patients cannot receive ICI therapy — either due to a medical contraindication or because ICI agents are not accessible. This protocol addresses the evidence-based approach for that population.
Clinical Scenario
Patients with advanced or metastatic clear-cell renal cell carcinoma who have a contraindication to immune checkpoint inhibitors, or for whom ICI therapy is not available. In this setting, ICI-containing combinations are not an option and an alternative first-line strategy is required.
References
DOI: 10.1016/j.annonc.2024.05.537
- In patients with a contraindication to ICIs, or where ICIs are not available, sunitinib, pazopanib or tivozanib may be used.
- Sunitinib, pazopanib and tivozanib are alternatives to first-line PD-1-targeted combinations when ICI therapy is contraindicated or not available.
- Cabozantinib is also an alternative in IMDC intermediate- and poor-risk disease for those patients who cannot receive first-line PD-1-targeted therapy.