Advanced/Metastatic Clear Cell Renal Cell Cancer (RCC)

Immunotherapy plus VEGF TKI (IO-VEGF TKI)

Suitable for patients with favourable, intermediate or poor risk disease who have no contraindication to immune checkpoint inhibitors.

Immunotherapy plus immunotherapy (IO-IO) 

Suitable for patients with intermediate or poor risk disease only, who have no contraindication to immune checkpoint inhibitors.

VEGF TKI Monotherapy (future immunotherapy option)

VEGF TKI + immunotherapy is preferred for Advanced/Metastatic RCC. However monotherapy VEGF TKI via this pathway can be considered in these groups of patients as outlined below

• Patients with favourable risk disease
• Patients who are unsuitable for immune checkpoint inhibitors in the first line setting of any risk group i.e. favourable, intermediate or poor risk disease (but who may become eligible in future)
• Historical patients on long term treatment with a first line VEGF TKI of any risk group i.e. favourable, intermediate or poor risk disease

VEGF TKI Monotherapy (no future immunotherapy option)

VEGF TKI + immunotherapy is preferred for Advanced/Metastatic RCC. However monotherapy VEGF TKI via this pathway can be considered in these groups of patients as outlined below

• Patients with favourable risk disease
• Patients who have an absolute contraindication to immune checkpoint inhibitors, including patients who are refractory to adjuvant immunotherapy, of any risk group i.e. favourable, intermediate or poor risk disease.

There is no comparative evidence to demonstrate superiority of one immune checkpoint inhibitor / VEGF tyrosine kinase inhibitor (VEGF TKI) over the other. Thus all are included as treatment options with the choice based on individual patient factors / expected side effect profile.

Patients should not routinely receive the same tyrosine kinase inhibitor in more than one line of therapy.