9
Figure 3. Metastases-Directed Treatment
Patients with low volume
metastatic disease
Definitive metastasis-
directed therapies
(i.e., surgical resection
[metastasectomy], ablative
measures, or radiotherapy)
may be offered
Patients receiving complete
metastasectomy
TKIs are not routinely
recommended
following surgery
Recommendation 6.2.1
➤ Patients with brain metastases from metastatic clear cell renal cell
carcinoma should receive brain-directed local therapy with radiation
therapy and/or surgery. (Strong recommendation; CB-B-H)
Recommendation 6.2.2
➤ No recommendation regarding optimal systemic therapy for patients
with metastatic clear cell renal cell carcinoma and brain metastases
can be made. (Strong recommendation; CB-U-N/A)
Recommendation 6.3
➤ Patients with metastatic clear cell renal cell carcinoma with
sarcomatoid features should receive immune checkpoint inhibitor-
based combination first-line treatment (ipilimumab plus nivolumab,
or alternatively, an immune checkpoint inhibitor plus a TKI). (Strong
recommendation; EB-B-H)
d
d
See Figure 4: Special Patient Subtypes.
