Clear cell renal cell carcinoma
Prepared with OnCo (onco.cc/prep/clear-cell-rcc/). Orientation, not medical advice; your team knows your case.
My details
What I know, what is unclear, changes to discuss
Saved in this browserMy questions
20 on the sheet- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example VHL inactivation and 3p loss, PBRM1, SETD2, BAP1 mutations, IMDC risk group, Sarcomatoid features, Germline VHL testing in young or multifocal disease), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
- 5.For my situation (small renal mass), which of the standard options do you recommend and why?
- 6.For my situation (localised, higher risk), which of the standard options do you recommend and why?
- 7.Am I a candidate for Pembrolizumab, and what side effects should I expect?
- 8.How do the results of KEYNOTE-564 apply to someone like me?
- 9.For my situation (metastatic, first line), which of the standard options do you recommend and why?
- 10.Am I a candidate for Pembrolizumab, Axitinib, Lenvatinib or related drugs, and what side effects should I expect?
- 11.How do the results of KEYNOTE-426 and CheckMate 214 apply to someone like me?
- 12.For my situation (later lines), which of the standard options do you recommend and why?
- 13.Am I a candidate for Cabozantinib, Belzutifan, Everolimus, and what side effects should I expect?
- 14.For my situation (vhl disease), which of the standard options do you recommend and why?
- 15.Am I a candidate for Belzutifan, and what side effects should I expect?
- 16.Are there clinical trials I could join, for example of Belzutifan, HIF-2α?
- 17.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 18.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 19.I read that “No validated biomarker chooses between immunotherapy doublets”. How does that affect my plan?
- 20.I read that “Most metastatic patients still progress within two to three years”. How does that affect my plan?
The words I may hear
- Cryoablation: Destroying a tumour by freezing it with a needle that reaches minus 40°C or below; the ice ball is visible on CT, so the treated zone can be watched forming.
Tests and results to bring
Biomarker results to ask for: VHL inactivation and 3p loss, PBRM1, SETD2, BAP1 mutations (prognosis), IMDC risk group (metastatic disease), Sarcomatoid features, Germline VHL testing in young or multifocal disease.
Scans and tests linked to this cancer: Active surveillance.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Localised, higher risk: Radical or partial nephrectomy followed by one year of adjuvant pembrolizumab (KEYNOTE-564, overall survival benefit). (Pembrolizumab, KEYNOTE-564)
- Small renal mass: Partial nephrectomy, thermal ablation or active surveillance by size, growth and patient fitness. (Thermal ablation (RFA, microwave, cryo), Cryoablation, Active surveillance)
- Metastatic, first line: Pembrolizumab plus axitinib (KEYNOTE-426) or lenvatinib, nivolumab plus cabozantinib, or nivolumab plus ipilimumab (CheckMate 214) for intermediate and poor risk; cytoreductive nephrectomy only in selected patients. (Pembrolizumab, Axitinib, Lenvatinib, Nivolumab, Cabozantinib, Ipilimumab, KEYNOTE-426, CheckMate 214)
- VHL disease: Belzutifan for kidney, pancreatic and CNS tumours that would otherwise need surgery; surveillance of the kidneys with nephron-sparing surgery when tumours reach 3 cm. (Belzutifan)
- Later lines: Cabozantinib, axitinib, belzutifan (LITESPARK-005), lenvatinib plus everolimus, tivozanib. (Cabozantinib, Belzutifan, Everolimus, HIF-2α)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.