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11 standard-of-care settings across 5 lines and 3 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
| Line | All comers | IMDC risk | Risk group |
|---|---|---|---|
| Early / localised | 3 | · | 1 |
| Advanced, first line | 1 | 2 | · |
| Second line | 1 | · | · |
| Special situations | 1 | · | · |
| Other settings | 2 | · | · |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Localised | Partial/radical nephrectomy or ablation; adjuvant pembrolizumab ± belzutifan for high risk. | NCCN Guidelines: Kidney Cancer | 98 | |
| All comers | Small renal mass (<4 cm) | Active surveillance, partial nephrectomy (usually robotic), or thermal ablation depending on growth, comorbidity, and biopsy; renal mass biopsy increasingly used. | NCCN · 2A | 40 | |
| All comers | Localised T1b-T3 | Partial or radical nephrectomy; no adjuvant therapy for low/intermediate risk. | NCCN · 1 (surgery) | 40 | |
| Risk group | High-risk after nephrectomy (clear-cell) | Adjuvant pembrolizumab for 1 year (KEYNOTE-564, OS benefit); pembrolizumab + belzutifan approved 2026 (LITESPARK-022); sunitinib adjuvant rarely used. | NCCN · 1 (pembrolizumab)ESMO-MCBS · A | 98 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Metastatic | IO-TKI or IO-IO doublet; belzutifan, cabozantinib, lenvatinib-everolimus later. | NCCN Guidelines: Kidney Cancer | 98 | |
| IMDC risk | Metastatic, intermediate/poor risk, first line | Nivolumab + ipilimumab, or an IO-TKI doublet (pembrolizumab + axitinib, nivolumab + cabozantinib, lenvatinib + pembrolizumab); cytoreductive nephrectomy deferred or omitted (CARMENA) except in selected cases. | NCCN · 1 (preferred: all four regimens)ESMO-MCBS · 4 | 98 | |
| IMDC risk | Metastatic, favourable risk, first line | IO-TKI doublet (PFS benefit; OS benefit unproven in this group) or single-agent TKI (sunitinib, pazopanib) with deferred IO; active surveillance for indolent low-volume disease. | NCCN · 1 (IO-TKI); 2A (TKI alone) | 98 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Second line after IO-based therapy | Single-agent TKI (cabozantinib, axitinib, lenvatinib + everolimus, tivozanib); belzutifan after both IO and VEGF-TKI (LITESPARK-005). Do not rechallenge PD-1 (CONTACT-03, TiNivo-2). | NCCN · 1 (cabozantinib, belzutifan) | 95 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Oligometastatic / oligoprogressive disease | Metastasectomy or SBRT to limited sites with continuation of systemic therapy or observation. | NCCN · 2A | 40 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Non-clear-cell RCC | Cabozantinib (PAPMET), lenvatinib + pembrolizumab (KEYNOTE-B61), or nivolumab + cabozantinib; MET inhibitors for MET-driven papillary; trials preferred. | NCCN · 2A | 98 | |
| All comers | VHL disease | Belzutifan for VHL-associated RCC, CNS haemangioblastoma, and pNET not requiring immediate surgery (LITESPARK-004). | NCCN · 1 | 92 |
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.