Papillary RCC presenting at an advanced or metastatic stage is not managed identically to other renal cell carcinoma subtypes. Systemic therapy selection is guided by evidence specific to this histology, including data on which agents have demonstrated meaningful benefit in the pRCC population.
Treatment selection across lines is guided by prior therapy history — in the second-line setting, the approach prioritises agents not yet administered to the patient, with best supportive care a recognised option for suitable individuals. The full sequenced algorithm, including first-line selection criteria and complete options, is accessible via the protocol below.
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.
Second-line therapy may focus on agents that have not been used previously.
BSC can be considered in selected patients due to the lack of data on systemic therapy.
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