First-Line Treatment of Advanced or Metastatic Clear-Cell Renal Cell Carcinoma Without Contraindication to Immune Checkpoint Inhibitors

Patients with advanced or metastatic clear-cell renal cell carcinoma (ccRCC) who are eligible for immune checkpoint inhibitor (ICI) therapy represent a distinct population for which specific evidence-based first-line regimens apply. ICI eligibility is a key decision point that shapes the treatment approach in this setting.

Clinical scenario Advanced or metastatic clear-cell renal cell carcinoma, without contraindication to immune checkpoint inhibitors.

Treatment approach (first-line)

Current evidence supports combination immune checkpoint inhibitor-based regimens as the standard of care, with the preferred combination informed by IMDC risk group. Certain combinations apply across all risk groups; others are reserved for intermediate- or poor-risk disease.

The complete regimen options, risk-adapted selection guidance, and full protocol details are available via the structured regimen below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.annonc.2024.05.537

Lenvatinib–pembrolizumab, axitinib–pembrolizumab or cabozantinib–nivolumab is recommended for first-line treatment of advanced ccRCC, irrespective of IMDC risk group.

Ipilimumab–nivolumab is recommended as first-line treatment for IMDC intermediate- and poor-risk disease and is an option for favourable-risk disease.

Axitinib–toripalimab is an option for patients with intermediate- or poor-risk disease.

In patients with a contraindication to ICIs, or where ICIs are not available, sunitinib, pazopanib or tivozanib may be used.

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