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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Initial systemic therapy for metastatic clear cell renal cell carcinoma

Initial systemic therapy for metastatic clear cell renal cell carcinoma

Patients with advanced or metastatic clear cell RCC are typically treated with systemic therapy as initial treatment. The decision to start systemic therapy and the selection of agent(s) depend on disease-related symptoms, patient comorbidities, and tumor risk stratification. Listed treatments are preferred options, although alternative agents that are not listed may also be effective. Clinical trials are encouraged if available. For further details on evidence, refer to UpToDate content on systemic therapy for advanced clear cell RCC and targeted therapy for RCC.

Select patients may be candidates for cytoreductive nephrectomy prior to initiation of immunotherapy. Refer to UpToDate content on surgical management of RCC.

RCC: renal cell carcinoma; IMDC: International Metastatic Renal Cell Carcinoma Database Consortium; KPS: Karnofsky performance status; LLN: lower limit of normal; ULN: upper limit of normal; VEGFR: vascular endothelial growth factor receptor.

* Patients with limited disease on imaging are usually asymptomatic. However, the decision to treat must take into account multiple factors, including the rate of growth, location of tumor (eg, proximity to vital organs with potential for damage), and symptoms.

¶ For patients with limited burden, favorable-risk disease who desire a more aggressive management approach, options for antiangiogenic therapy include sunitinib or pazopanib.

Δ For patients who are ineligible for or decline initial treatment with immunotherapy combinations, we offer antiangiogenic therapy that incorporates a VEGFR inhibitor. For patients with substantial burden, favorable risk disease, options include lenvatinib plus everolimus, sunitinib, and pazopanib. For those with intermediate or poor-risk disease, options include lenvatinib plus everolimus or cabozantinib.

◊ Nivolumab plus ipilimumab offers the opportunity for curative intent therapy through durable responses, preserving overall survival benefit, and improving treatment-free survival. By indirect comparison of randomized trials, nivolumab plus ipilimumab confers these treatment benefits to a greater degree than combination immunotherapy plus antiangiogenic therapy, despite having a relatively lower objective response rate. For patients who are not anticipated to tolerate the toxicities of nivolumab plus ipilimumab, immunotherapy plus antiangiogenic therapy is an appropriate alternative.
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