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1、NCCN org NCCN Guidelines for Patients available at www nccn org patients Version 4 2019 04 25 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Clinical Pr
2、actice Guidelines in Oncology NCCN Guidelines Kidney Cancer Version 4 2019 April 25 2019 Continue Continue NCCN Guidelines Panel Disclosures Hematology oncology Patient advocacy Internal medicine Radiotherapy Radiation oncology Medical oncology Urology Pathology Discussion writing committee member R
3、obert J Motzer MD Chair Memorial Sloan Kettering Cancer Center Eric Jonasch MD Vice chair The University of Texas MD Anderson Cancer Center Neeraj Agarwal MD Huntsman Cancer Institute at the University of Utah Sam Bhayani MD Siteman Cancer Center at Barnes Jewish Hospital and Washington University S
4、chool of Medicine William P Bro Kidney Cancer Association Sam S Chang MD Vanderbilt Ingram Cancer Center Toni K Choueiri MD Dana Farber Brigham and Women s Cancer Center Brian A Costello MD MS Mayo Clinic Cancer Center Ithaar H Derweesh MD UC San Diego Moores Cancer Center Rodney Ellis MD Case Compr
5、ehensive Cancer Center University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute Mayer Fishman MD PhD Moffitt Cancer Center Thomas H Gallagher MD Fred Hutchinson Cancer Research Center Seattle Cancer Care Alliance Saby George MD Roswell Park Comprehensive Cancer Center
6、 John L Gore MD MS Fred Hutchinson Cancer Research Center Seattle Cancer Care Alliance Naomi Haas MD Abramson Cancer Center at the University of Pennsylvania Steven L Hancock MD Stanford Cancer Institute Michael R Harrison MD Duke Cancer Institute Won Kim MD UCSF Helen Diller Family Comprehensive Ca
7、ncer Center Christos Kyriakopoulos MD University of Wisconsin Carbone Cancer Center Chad LaGrange MD Fred 17 1317 1324 lPatients with excellent performance status and normal organ function mSee Risk Models to Direct Treatment Predictors of Short Survival Used to Select Patients for Temsirolimus KID
8、C nIn clear cell and non clear cell RCC with predominant sarcomatoid features gemcitabine doxorubicin category 2B and gemcitabine sunitinib category 2B have shown benefit KID 4 RELAPSE OR STAGE IV FIRST LINE THERAPY FOR CLEAR CELL HISTOLOGY Preferred regimensOther recommended regimensUseful under ce
9、rtain circumstances Favorable riskj Axitinib pembrolizumab Pazopanib Sunitinib Ipilimumab nivolumab Cabozantinib category 2B Active surveillancek Axitinib category 2B Bevacizumab interferon alfa 2b category 1 High dose IL 2l Poor intermediate riskj Ipilimumab nivolumab category 1 Axitinib pembrolizu
10、mab category 1 Cabozantinib Pazopanib category 1 Sunitinib category 1 Axitinib category 2B Bevacizumab interferon alfa 2b category 1 High dose IL 2l Temsirolimus category 1 m RELAPSE OR STAGE IV SUBSEQUENT THERAPY FOR CLEAR CELL HISTOLOGYn Preferred regimensOther recommended regimensUseful under cer
11、tain circumstances Cabozantinib category 1 Nivolumab category 1 Ipilimumab nivolumab Axitinib category 1 Lenvatinib everolimus category 1 Axitinib pembrolizumab Everolimus Pazopanib Sunitinib Bevacizumab category 2B Sorafenib category 2B High dose IL 2 for selected patientsl category 2B Temsirolimus
12、 category 2B m NCCN Guidelines Version 4 2019 Kidney Cancer Version 4 2019 04 25 19 2019 National Comprehensive Cancer Network NCCN All rights reserved NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN Note All recommendations are
13、category 2A unless otherwise indicated Clinical Trials NCCN believes that the best management of any patient with cancer is in a clinical trial Participation in clinical trials is especially encouraged NCCN Guidelines Index Table of Contents Discussion Printed by Maria Chen on 5 5 2019 11 49 27 PM F
14、or personal use only Not approved for distribution Copyright 2019 National Comprehensive Cancer Network Inc All Rights Reserved mSee Risk Models to Direct Treatment Predictors of Short Survival Used to Select Patients for Temsirolimus KID C nIn clear cell and non clear cell RCC with predominant sarc
15、omatoid features gemcitabine doxorubicin category 2B and gemcitabine sunitinib category 2B have shown benefit oFor collecting duct or medullary subtypes partial responses have been observed with cytotoxic chemotherapy carboplatin gemcitabine carboplatin paclitaxel or cisplatin gemcitabine and other
16、platinum based chemotherapies currently used for urothelial carcinomas KID 5 HLRCC Hereditary leiomyomatosis and renal cell cancer RELAPSE OR STAGE IV SYSTEMIC THERAPY NON CLEAR CELL HISTOLOGYn o Preferred regimensOther recommended regimensUseful under certain circumstances Clinical trial Sunitinib Cabozantinib Everolimus Axitinib Bevacizumab Erlotinib Lenvatinib everolimus Nivolumab Pazopanib Bevacizumab erlotinib for selected patients with advanced papillary RCC including HLRCC Bevacizumab eve
