The European Association of Urology (EAU) Guidelines for Renal Cell Carcinoma (RCC) were updated in March 2021. The full updated guidelines can be found on our website by clicking here: Below is a summary of the most important changes:

  • Use MRI and ultrasound for further characterisation of small renal masses, tumour thrombus and differentiation of unclear renal masses, if the results of contrast-enhanced CT are not clear
  • Use TNM stage, tumour size, grade, and RCC subtype provide important prognostic information
  • Offer partial nephrectomy to patients with T2 tumours and a solitary kidney or chronic kidney disease, if technically feasible
  • Intensify follow-up in patients with a positive surgical margin
  • Offer active surveillance or thermal ablation to frail and/or patients with co-morbidities with small renal masses
  • Perform a percutaneous renal mass biopsy prior to, and not concomitantly with thermal ablation
  • When thermal ablation or active surveillance are offered, discuss with patients about the harms/benefits with regards to oncological outcomes and complications
  • Do not routinely offer thermal ablation for tumours > 3 cm and cryoablation for tumours > 4 cm
  • In patients with clinically enlarged lymph nodes, surgically remove lymph nodes to guide staging, prognosis and follow-up
  • In case of metastatic disease, discuss surgery within the context of a multidisciplinary team
  • Do not offer adjuvant therapy with sorafenib, pazopanib, everolimus, girentuximab or axitinib
  • Do not offer adjuvant sunitinib following surgically resected high-risk clear-cell renal cell carcinoma
  • Discuss delayed cytoreductive nephrectomy in patients who derive clinical benefit from systemic therapy
  • Do not offer tyrosine kinase inhibitor treatment to metastatic RCC patients after metastasectomy and no evidence of disease
  • Offer pembrolizumab plus axitinib, lenvatinib plus pembrolizumab or nivolumab plus cabozantinib to treatment-naive patients with clear-cell metastatic RCC
  • Administer nivolumab plus ipilimumab, pembrolizumab plus axitinib, lenvatinib plus pembrolizumab and nivolumab plus cabozantinib in centres with experience of immune combination therapy and appropriate supportive care within the context of a multidisciplinary team
  • Offer axitinib, cabozantinib or lenvatinib as subsequent treatment to patients who experience treatment-limiting immune-related adverse events after treatment with the combination of axitinib plus pembrolizumab, cabozantinib plus nivolumab or lenvatinib plus pembrolizumab
  • Updated EAU Guidelines recommendations for the first-line treatment of metastatic clear cell RCC:
    • Favourable risk patients: standard of care with nivolumab/cabozantinib, pembrolizumab/axitinib, or pembrolizumab/lenvatinib. Alternative for patients who cannot receive or tolerate immune checkpoint inhibitorssunitinib or pazopanib
    • Intermediate or poor risk patients: nivolumab/cabozantinib, pembrolizumab/axitinib, pembrolizumab/lenvatinib or nivolumab/ipilimumab. Alternative for patients who can not receive or tolerate immune checkpoint inhibitors: cabozantinib, sunitinib or pazopanib
  • Offer nivolumab or cabozantinib for immune checkpoint inhibitor-naive vascular endothelial growth factor receptor (VEGFR)-refractory clear-cell metastatic RCC after one or two lines of therapy
  • Perform functional follow-up (renal function assessment and prevention of cardiovascular events) for patient who have had partial nephrectomy or radical nephrectomy (RN)
  • Consider curtailing follow-up when the risk of dying from other causes is double that of the recurrence risk of RCC.