Summary Recommendations

First-line

Second-line

Third-line

CCRCC

First Option: Clinical trials

Good/Intermediate Risk: Sunitinib

Bevacizumab + IFN-

Pazopanib

High-dose IL-2

Active surveillance

Poor Risk:

Temsirolimus

Sunitinib

Pazopanib*

Best supportive care

First Option: Clinical trials

Cytokine Refractory: Sorafenib

Pazopanib

Axitinib

Sunitinib

Bevacizumab + IFN-

Best supportive care

Prior VEGF Therapy: Everolimus

Axitinib

Anti-VEGF therapy not previously used

Best supportive care

Prior MTOR:

Anti-VEGF targeted therapy

Best supportive care

Anti-VEGF therapy not previously used †

Best supportive care

Non-CCRCC

No standard treatment available, patient should be treated in the framework of a clinical trial if available.

Best supportive care is an option.

CCRCC: Clear cell renal cell carcinoma; VEGF: Vascular endothelial growth factor

* No strong supporting evidence, to be used only as an alternative to sunitinib.

† Patient should be educated of the lack of data guiding third-line treatment for mRCC.