Renal Cell Carcinoma Clinical Practice Guidelines (EAU, 2021)

European Association of Urology

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

November 02, 2021

Updated guidelines on the management of renal cell carcinoma (RCC) were published in October 2021 by the European Association of Urology (EAU) in European Urology.[1]

If the results of contrast-enhanced computed tomography (CT) are indeterminate, use non-ionizing modalities, including magnetic resonance imaging (MRI) and contrast-enhanced ultrasound, for further characterization of small renal masses and tumor thrombus and differentiation of unclear renal masses.

Use the World Health Organization/International Society of Urological Pathology (WHO/ISUP) grading system and classify RCC type.

Do not routinely use molecular markers to assess prognosis.

Offer partial nephrectomy, if technically feasible, to patients with T2 tumors and a solitary kidney or chronic kidney disease.

Offer active surveillance or thermal ablation (TA) to frail and/or comorbid patients with small renal masses. Do not routinely offer TA for tumors > 3 cm or cryoablation for tumors > 4 cm.

In patients with locally advanced RCC, after nephrectomy do not offer adjuvant therapy with sorafenib, pazopanib, everolimus, girentuximab, or axitinib.

Do not offer tyrosine kinase inhibitor treatment to patients with metastatic RCC who have no evidence of disease after metastasectomy.

In treatment-naive patients with clear-cell metastatic RCC, offer pembrolizumab plus axitinib, lenvatinib plus pembrolizumab, or nivolumab plus cabozantinib as first-line therapy.

In immune checkpoint inhibitor–naive patients with clear-cell metastatic RCC refractory to one or two lines of therapy with vascular endothelial growth factor receptor (VEGFR) inhibitors, offer nivolumab or cabozantinib.

For more information, please go to Renal Cell Carcinoma


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