OnCo
pairingsPairing

IMDC risk → first-line regimen choice (RCC)

A simple clinical score decides between two immunotherapies together or one immunotherapy with a targeted pill.

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.

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.

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