First-line treatment for advanced or metastatic papillary renal cell carcinoma

Papillary renal cell carcinoma presenting at an advanced or metastatic stage requires a distinct first-line approach. The choice of therapy is guided by current evidence that distinguishes preferred single-agent options from alternative regimens.

Clinical scenario

This protocol applies to patients with advanced or metastatic papillary renal cell carcinoma (pRCC) who are initiating first-line systemic therapy. The papillary histological subtype informs the selection of treatment options compared with clear-cell disease.

Treatment approach (partial overview)

A preferred first-line monotherapy is established for this setting, supported by evidence of progression-free survival benefit. Additional single-agent alternatives and combination regimens exist for eligible patients.

The complete regimen — including preferred agent, alternatives, and the criteria for choosing between monotherapy and combination approaches — is in the full protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.annonc.2024.05.537

Cabozantinib is the preferred first-line monotherapy for advanced pRCC, having demonstrated a PFS (but not OS) advantage compared with sunitinib.

Cabozantinib is the preferred first-line monotherapy for advanced pRCC without additional molecular testing.

Alternative single-agent options include sunitinib and pembrolizumab.

Lenvatinib–pembrolizumab and cabozantinib–nivolumab have impressive response rates but are not proven to be superior to single-agent therapy. They may be considered as alternatives to single-agent therapy.

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