# IMDC risk → first-line regimen choice (RCC)

Source: https://onco.cc/pairings/risk-directed-first-line-rcc/  
OnCo record `risk-directed-first-line-rcc` (Pairing). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Fields

- Kind: Pairing
- Last checked: 2026-09-07
- Pairs: Immune checkpoint inhibitors + Small-molecule kinase inhibitors
- Type: diagnostic-therapeutic
- 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.

## Sources

- ClinicalTrials.gov NCT02231749: CheckMate 214: https://clinicaltrials.gov/study/NCT02231749

## Connected records

- cancers: [Renal cell carcinoma](https://onco.cc/cancers/rcc/)
- drugs: [Axitinib](https://onco.cc/drugs/axitinib/), [Cabozantinib](https://onco.cc/drugs/cabozantinib/), [Ipilimumab](https://onco.cc/drugs/ipilimumab/), [Lenvatinib](https://onco.cc/drugs/lenvatinib/), [Nivolumab](https://onco.cc/drugs/nivolumab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/)
- terms: [IMDC risk groups (favourable / intermediate / poor)](https://onco.cc/terms/imdc-risk/), [Sarcomatoid differentiation (RCC)](https://onco.cc/terms/sarcomatoid-rcc/)
- technologies: [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/), [Small-molecule kinase inhibitors](https://onco.cc/technologies/kinase-inhibitors/)

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JSON: https://onco.cc/api/v1/entities/risk-directed-first-line-rcc.json