Core messages
The Oncology Guideline Program has updated its S3 renal cell carcinoma guideline. For the first time, the revised version contains a chapter on diagnosis and therapy of non-clear cell renal cell carcinoma.
Treatment recommendations for non-clear cell renal cell carcinomas
According to the WHO classification, there are more than 15 different entities in the group of non-clear cell renal cell carcinomas.«Non-clear cell renal carcinomas are a very heterogeneous group. That is why we are faced with the challenge that they are often not taken into account in therapy studies,» explained Christian Doehn from the Urologikum Lübeck, who coordinates the guideline together with Susanne Krege, Director of the Department of Urology at the Evangelische Kliniken Essen Mitte. The limited data situation makes clear therapy strategies difficult. In the guideline, the authors provide an overview of the existing study situation for the first time and make concrete recommendations to improve the treatment of patients with these tumor entities.
Recommendation for adjuvant immunotherapy with Pembrolizumab
The updated guideline also recommended adjuvant immunotherapy using the checkpoint inhibitor pembrolizumab for the first time.The recommendation is linked to the presence of an increased risk constellation for tumor recurrence. Adjuvant immunotherapy with the checkpoint inhibitor pembrolizumab should therefore be performed in patients with clear cell renal cell carcinoma with intermediate-high and high risk. However, no valid overall survival data are yet available, according to the guideline authors.
No adjuvant therapy for non-metastatic renal cell carcinoma
The recommendations for neoadjuvant therapy with regard to renal cell carcinoma continue to be assessed as «correct» by the guideline group, according to an accompanying communication from the German Cancer Society. Previous studies have shown only a small reduction in the size of the tumor due to neoadjuvant therapies. For non-metastatic tumors, therefore, no neoadjuvant therapy is recommended before primary tumor resection. However, the guideline group admits that there is still a considerable need for research into both neoadjuvant and adjuvant therapies.
According to data from the Robert Koch Institute, about 14,800 malignant kidney tumors occurred in 2018.Men are affected almost twice as often as women. Nearly 95 percent of kidney tumors in adults were renal cell carcinomas. The relative 5-year survival rate is quite high at 78 percent for men and 76 percent for women. The standard curative therapy is the removal of the tumor, either by the complete removal of the affected kidney or by a partial kidney removal.
The entire S3 guideline for renal cell carcinoma is available on the Oncology Guideline Program website: https://www.leitlinienprogramm-onkologie.de/leitlinien/nierenzellkarzinom/. In addition, the content is integrated into the free guideline app. Android smartphone and iPhone users can download the guidelines app here: https://leitlinienprogramm-onkologie.de/app//p>
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Source — https://www.univadis.de/viewarticle/nicht-klarzellige-nierenkarzinome-aktualisierte-s3-leitlinie-2023a100053g