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Further to the results from recent studies, particularly CheckMate-214, the European Association of Urology (EAU) guidelines for standard first-line treatment for patients with metastatic renal cell carcinoma (RCC) are likely to be updated.
The results from CheckMate-214 showed the combination of immunotherapy drugs ipilimumab and nivolumab to be superior to standard first-line treatment with sunitinib in patients with intermediate- and poor-risk metastatic RCC. However, this combination treatment is toxic, as 24% of all patients in the study needed to discontinue.
The ipilimumab plus nivolumab combination for the first-line treatment of metastatic RCC is currently going through a NICE appraisal and the recommendation from this appraisal is expected in the autumn.
Sunitinib and pazopanib continue to remain the agents of choice in favourable-risk patients. Patients who progress on immunotherapy should be offered TKI treatment as a second-line alternative.