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Fig. 1 | Journal for ImmunoTherapy of Cancer

Fig. 1

From: Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of renal cell carcinoma

Fig. 1

Stage IV renal cell carcinoma (RCC) immunotherapy treatment algorithm. All treatment options shown may be appropriate. The final selection of therapy should be individualized based on patient eligibility and the availability of each therapy at the treating physician’s discretion. 1) “Risk” refers to prognostic risk group per Memorial Sloan Kettering Cancer Center (MSKCC) and/or International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) classification [49, 83]. 2) For patients with small-volume, indolent metastases, an initial period of observation can be considered accounting for patient age/comorbidities, patient preference, and toxicity of available therapy. 3) A clinical trial, including those that are immunotherapy-based, should be considered in all RCC patients in all lines of therapy. 4) As noted in the manuscript, HD IL2 should be considered and discussed with mRCC patients with clear cell histology and good performance status. 5) For patients with advanced non-clear cell renal cell carcinoma (RCC), if available a clinical trial is the preferred initial treatment option, including trials of checkpoint inhibitors for which limited data exists regarding efficacy in non-clear cell RCC. If unavailable, then a VEGFR tyrosine kinase inhibitor (TKI) is preferred given results from two small randomized trials showing a slight advantage over mTOR inhibitors in this setting [81, 82]. 6) Nivolumab is an appropriate initial recommendation in refractory RCC in the absence of contraindications given the overall survival benefit and tolerability. Other options (TKI, HD IL-2 and mTOR inhibitors) can be considered depending on patient performance status, comorbidities, prior therapy received and preference. Figure adapted from Kaufman et al., 2013 [18]

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