Recommendation 1.1
➤ The diagnosis of metastatic clear cell renal cell carcinoma should
ideally involve comparison of tissue acquired outside the site of
primary disease to the primary histology. Histologic evaluation should
include common markers of clear cell renal cell carcinoma including
paired box gene 8 (PAX8) and Carbonic anhydrase IX (CAIX). (Strong
recommendation; EB-B-H)
Recommendation 1.2
➤ Radiographic diagnosis of metastatic clear cell renal cell carcinoma
may be applied in selected circumstances, such as settings in which
a prior diagnosis of renal cell carcinoma has been established,
when metastatic tissue is not readily accessible by biopsy, or when
response evaluation criteria in solid tumors or when RECIST 1.1
measurable disease is evident, especially within a year of the initial
diagnosis. (Weak recommendation; CB-B-L)
Diagnosis
Treatment
Recommendation 2.1
➤ Select patients (see Practical Information) with metastatic clear cell
renal cell carcinoma may be offered cytoreductive nephrectomy.
(Strong recommendation; EB-B-H)
a
Practical Information: Select patients include those with optimally 1 International
Metastatic RCC Database Consortium (IMDC) risk factor who can have a
significant majority of their tumor burden removed at the time of surgery.
a
See Figure 1: First-line treatment.
Recommendation 3.1
➤ Select patients with metastatic clear cell renal cell carcinoma (see
Practical Information) may be offered an initial active surveillance
strategy. (Strong recommendation; EB-B-M)
Practical Information: Select patients include those with IMDC favorable and
intermediate risk, patients with limited or no symptoms related to disease, a favorable
histologic profile, a long interval between nephrectomy and the development of
metastasis or with limited burden of metastatic disease.
