SITC Renal Cell Carcinoma
Immunotherapy Guideline

SITC's Cancer Immunotherapy Guidelines program is a collection of clinical practice guidelines (CPGs) developed by multi-disciplinary panels of experts who draw from their own practical experience as well as evidence in the published literature and clinical trial data to develop evidence- and consensus-based recommendations. SITC uses as a model the Institute of Medicine's 2011 "Standards for Developing Trustworthy Clinical Practice Guidelines" to ensure recommendations are unbiased, transparent, and balanced. 

The renal cell carcinoma guideline provides a valuable clinical decision-making tool to help guide oncologists and other advanced practice providers on topics including biomarkers, the selection of appropriate immunotherapeutic regimens, treatment response and monitoring, toxicity management, and patient quality of life considerations. 

Published Guideline

READ GUIDELINE

• Updated narrative text and recommendations based on approval of pembrolizumab for adjuvant treatment of RCC.
• Updated narrative text, tables, recommendations, and treatment algorithm based on approvals of pembrolizumab in combination with lenvatinib and nivolumab in combination with cabozantinib.
  
  
  

Guideline Education

SITC is pleased to offer companion education resources in support of the published renal cell carcinoma CPG. These activities feature faculty comprised of the guideline expert panel and are designed to provide a deeper understanding of the recommendations in the SITC guidelines and how to apply them in various clinical scenarios.  The education available features one-hour webinars that take a deeper look at the guideline recommendations as well as mini-modules on a specific topic within the guideline content. Below is a list of the available educational resources for this CPG, available free and on-demand.

Webinars:

• Immunotherapy for the Treatment of Renal Cell Carcinoma
  • Leading experts in cancer immunotherapy present an overview of the publication "The Society for Immunotherapy of Cancer Consensus Statement on Immunotherapy for the Treatment of Advanced Renal Cell Carcinoma (RCC)."
    

• Practical Management Pearls for Immunotherapy for the Treatment of Renal Cell Carcinoma
  • This one hour on-demand webinar features members of the guideline Expert Panel. These faculty members discuss how to appraise and classify organ-specific considerations for immunotherapy agents and toxicities, identify and manage clinically significant uncommon toxicities, and determine optimal sequencing of immunotherapies in relapsed and/or refractory disease.

• Case Studies in Immunotherapy for the Treatment of Renal Cell Carcinoma- SITC CPG Webinar
  • This one hour on-demand webinar features members of the guideline Expert Panel. These faculty members discuss case studies that illustrate execution of SITC guideline recommendations, as well as discussion on difficult topics related to case management. 

Mini-Modules:

• Management of Clear Cell RCC with Large Metastatic Burden
  • Case presentation of a 67-year-old man with metastatic clear cell renal cell carcinoma (ccRCC) with symptomatic endobrachial disease. The presentation addresses appropriate therapy for patients of poor risk, according to the IMDC model, plus strengths and weaknesses associated with combination therapies, both immunotherapy combinations (IO/IO) and immunotherapy coupled with a tyrosine kinase inhibitor (IO/TKI). Data from the CheckMate 214 and CLEAR trials are also addressed. The mini module closes with a panel discussion of factors to consider when choosing an appropriate IO/TKI combination therapy. 

• Management of Toxicities
  • Presentation of practical information on the management of toxicities associated with VEGF or mTOR inihibitor monotherapy, nivolumab monotherapy, and combination therapies. Symptoms and management of skin and liver toxicities and hand-foot syndrome are of particular focus. Emphasizes the importance of a multi-disciplinary approach in managing toxicities with RCC therapies and provides insights on when to hold or continue immunotherapy if a patient exhibits adverse events associated with RCC treatment. This mini module ends with a panel discussion of patient tolerance of TKIs and how individual patient tolerances may necessitate changes to TKI therapy regimens. 

• Planning Immunotherapy Regimens for Challenging Patient Populations
  • Case presentation of a patient with metastatic RCC and Crohn's Disease. Addresses the role of anti-PD1 monotherapy for patients with autoimmune conditions or high risk of ipilimumab toxicity as well as data from the HCRN GU16-260 study.  Discusses when to discontinue RCC therapy, using melanoma treatment as a model. The mini module concludes with a panel discussion of factors to consider when discontinuing IO/TKI combination therapy and when re-starting immunotherapy in the event of RCC recurrence.