The European Association of Urology (EAU) guidelines are to be updated based on the results of the phase III Checkmate-214 clinical trial, which change the first-line standard treatment for metastatic renal cell carcinoma (RCC). The trial showed superior survival for a combination of ipilimumab and nivolumab, compared with the previous standard of care, in intermediate- and poor-risk patients with metastatic clear cell RCC. When the ipilimumab plus nivolumab combination is not safe or feasible, alternative agents such as sunitinib, pazopanib, and cabozantinib should be considered. Furthermore, at present, the data from the trial are immature in favourable-risk patients. Therefore, sunitinib or pazopanib remains the favoured agent for this subgroup of patients.
However, the ipilimumab plus nivolumab combination is currently in the process of being appraised by the National Institute for Health and Care Excellence (NICE) for untreated patients with advanced RCC, and the decision is not expected until October 2018. We will keep you updated with the progress of this appraisal.
The EAU Renal Cell Cancer (RCC) Guidelines Panel compiles clinical guidelines to provide urologists with evidence-based information and recommendations for the management of RCC. It must be emphasised that clinical guidelines present the best evidence available to the experts, but following guideline recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients, but rather help to focus decisions, also taking personal values and preferences, and the individual circumstances of patients into account.