{"entity":{"id":"risk-directed-first-line-rcc","kind":"pairing","name":"IMDC risk → first-line regimen choice (RCC)","aka":[],"tldr":"A simple clinical score decides between two immunotherapies together or one immunotherapy with a targeted pill.","summary":"Intermediate/poor risk: nivolumab-ipilimumab (durable remissions, treatment-free survival) or an IO-TKI doublet (higher response rate, less primary progression). Favourable risk: IO-TKI doublet or TKI alone, since IO-IO shows no OS gain there. Sarcomatoid features favour IO-based therapy regardless of risk.","asOf":"2026-09-07","links":[{"label":"ClinicalTrials.gov NCT02231749: CheckMate 214","url":"https://clinicaltrials.gov/study/NCT02231749"}],"tags":[],"related":[],"cancers":["rcc"],"sections":[],"technologies":[],"targets":[],"drugs":["nivolumab","ipilimumab","pembrolizumab","axitinib","cabozantinib","lenvatinib"],"companies":[],"institutions":[],"pathways":[],"terms":["imdc-risk","sarcomatoid-rcc"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"a":"checkpoint-inhibitor","b":"kinase-inhibitors","rationale":"CheckMate 214 benefit is confined to intermediate/poor risk; IO-TKI trials show PFS benefit across groups.","evidence":"Subgroup analyses of four phase 3 trials; no head-to-head IO-IO vs IO-TKI trial.","pairingType":"diagnostic-therapeutic"},"route":"/pairings/risk-directed-first-line-rcc/","neighbours":{"cancer":[{"id":"rcc","kind":"cancer","name":"Renal cell carcinoma","route":"/cancers/rcc/"}],"drug":[{"id":"axitinib","kind":"drug","name":"Axitinib","route":"/drugs/axitinib/"},{"id":"cabozantinib","kind":"drug","name":"Cabozantinib","route":"/drugs/cabozantinib/"},{"id":"ipilimumab","kind":"drug","name":"Ipilimumab","route":"/drugs/ipilimumab/"},{"id":"lenvatinib","kind":"drug","name":"Lenvatinib","route":"/drugs/lenvatinib/"},{"id":"nivolumab","kind":"drug","name":"Nivolumab","route":"/drugs/nivolumab/"},{"id":"pembrolizumab","kind":"drug","name":"Pembrolizumab","route":"/drugs/pembrolizumab/"}],"term":[{"id":"imdc-risk","kind":"term","name":"IMDC risk groups (favourable / intermediate / poor)","route":"/terms/imdc-risk/"},{"id":"sarcomatoid-rcc","kind":"term","name":"Sarcomatoid differentiation (RCC)","route":"/terms/sarcomatoid-rcc/"}],"technology":[{"id":"checkpoint-inhibitor","kind":"technology","name":"Immune checkpoint inhibitors","route":"/technologies/checkpoint-inhibitor/"},{"id":"kinase-inhibitors","kind":"technology","name":"Small-molecule kinase inhibitors","route":"/technologies/kinase-inhibitors/"}]}}