Immunotherapy for Metasta c RCC
IFN in the Treatment of RCC
➤ ➤ Do NOT use IFN, even in combination with bevacizumab and even at lower
IFN doses. (60%)
➤ ➤ Use IFN as a single agent. (13%)
Note: The recommendation against using IFN as a single agent is level A.
Role of PD-1 Blockade (either with An -PD-1 or An -PD-L1)
These recommenda ons are based only on the phase I and II data that were available
at the me.
➤ ➤ Preferred treatment for patients who progress on anti-VEGF TKI therapy
but have good ECOG PS (≤1):
• Anti-PD-1 agents in clinical trials or as a commercial agent, if available (67%)
• IL-2 in appropriate patients after TKIs (13%)
• Either axitinib or everolimus (6.7%)
Note: Due to their more favorable toxicity profiles, many patients and
physicians would prefer anti-PD-1 immunotherapy to HD IL-2.
Metasta c Non-Clear Cell RCC
➤ ➤ HD IL-2 should be reserved for patients with clear cell RCC. (A/B)
Note: There was lack of consensus on the initial treatment for patients with
metastatic non-clear cell RCC. Clinical trials are likely to be the best initial
treatment option for such patients, provided there is a strong scientific
rationale for the treatment. In the absence of a clinical trial, a VEGFR TKI is
preferred.
