Tom Powles on new ESMO guidelines for renal cancer

Tom Powles, Director of Barts Cancer Center, shared on X:

“New ESMO guidelines in advanced papillary renal cancer. While there is randomised data supporting Cabozantinib (PFS not OS). Sunitinib is still weakly supported. The single arm Len/pem and Cabo/nivo data look more active and is also recommended. 2nd line data is needed. .

Updated clear cell renal cancer guidelines by ESMO. Ipi/nivo now has additional weak support in IMDC good risk (I,C). Belzutifan gets strong support in 3rd line (I,B) but less strong 2nd line (VEGF TKI preferred). 1st line PD1/VEGF unchanged.

The ESMO guidelines make a clear distinction between papillary and other ‘non-clear cell’ renal cancers. Mixing these together has hampered new treatments. Sarcomatoid needs upfront PD1 combos. Other subgroups (chromaphobe etc). Need more data.

The ESMO guidelines gives a stronger support (I,A) for adjuvant pembrolizumab in appropriate intermediate and high risk renal cancer due to positive OS signal. Belzutifan is also recommended in VHL germ line altered localised RCC.”