Immunotherapy for Metasta c RCC
The recommenda ons below address the role of treatment with immunotherapy (versus
VEGF- or mTOR-targeted therapy) following nephrectomy, or in pa ents with recurrent
metasta c disease.
Surgery For Stage IV RCC
➤ ➤ Nephrectomy remains an important component of management of patients
with mRCC. (A for IFN and IL-2 and C for VEGF-targeted agents and resection
of oligometastases)
Role of Systemic Therapy For Resected Stage II/III RCC
➤ ➤ The current standard of care in the adjuvant setting is either observation
or enrollment in a clinical trial. (A for lack of efficacy of multiple therapies in
phase III trials)
• The panel was supportive of initiating studies utilizing programmed death (PD-1)
pathway blocking agents in the neoadjuvant and/or adjuvant setting. Such trials
are in development (Table 1).
High Dose (HD) IL-2 in the Treatment of MRCC
➤ ➤ Selected patients with mRCC who have undergone nephrectomy should be
referred to a center of excellence for further discussion, as appropriate.
(A/B/C)
• All such patients should have a discussion regarding IL-2. (67%)
• Patients should be selected for this discussion. (33%)
Criteria for Considering IL-2 Therapy
➤ ➤ Only patients with clear cell histology should be considered for HD IL-2. (B/C)
• Patients with tumors having sarcomatoid features should receive IL-2, depending
upon the proportion of sarcomatoid features noted and the biologic behavior of
the disease (rapid or indolent). (60%)
• Patients with extensive granular features or Fuhrman grade 4 histology should
not receive IL-2. (13%)
• Clinical and physiologic criteria should also be evaluated prior to recommending
HD IL-2. (A)
▶ The following are established criteria for patients to undergo HD IL-2
treatment:
» Adequate heart and lung function
» ECOG performance status (PS) 0–1, preferably 0
» Age (physiologic versus chronologic), but the upper limit for both is usually in
the upper 70s
» Absence of central nervous system (CNS) metastases (or treated metastases
with no residual edema)
