Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with renal cell carcinoma

Abstract

•This article provides ESMO expert recommendations adapted for the treatment of renal cell carcinomas in Asian patients.•The aim was to provide guidance for the optimisation of the management of such patients across Asia.•The availability and applicability of certain procedures as they relate to certain of the recommendations are discussed. The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of renal cell carcinoma was published in 2019 with an update planned for 2021. It was therefore decided by both the ESMO and the Singapore Society of Oncology (SSO) to convene a special, virtual guidelines meeting in May 2021 to adapt the ESMO 2019 guidelines to take into account the ethnic differences associated with the treatment of renal cell carcinomas in Asian patients. These guidelines represent the consensus opinions reached by experts in the treatment of patients with renal cell carcinoma representing the oncological societies of China (CSCO), India (ISMPO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), Singapore (SSO) and Taiwan (TOS). The voting was based on scientific evidence and was independent of the current treatment practices and drug access restrictions in the different Asian countries. The latter were discussed when appropriate. The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of renal cell carcinoma was published in 2019 with an update planned for 2021. It was therefore decided by both the ESMO and the Singapore Society of Oncology (SSO) to convene a special, virtual guidelines meeting in May 2021 to adapt the ESMO 2019 guidelines to take into account the ethnic differences associated with the treatment of renal cell carcinomas in Asian patients. These guidelines represent the consensus opinions reached by experts in the treatment of patients with renal cell carcinoma representing the oncological societies of China (CSCO), India (ISMPO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), Singapore (SSO) and Taiwan (TOS). The voting was based on scientific evidence and was independent of the current treatment practices and drug access restrictions in the different Asian countries. The latter were discussed when appropriate. IntroductionIn 2018, an estimated 18.1 million new cases of cancer were diagnosed and 9.6 million cancer-related deaths recorded, worldwide.1Bray F. Ferlay J. Soerjomataram I. et al.Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin. 2018; 68: 394-424Google Scholar Of these, kidney cancer accounted for 2.2% (403 262) of new cases of cancer across both sexes, and 1.8% (175 098) of cancer deaths.1Bray F. Ferlay J. Soerjomataram I. et al.Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin. 2018; 68: 394-424Google Scholar Significantly, almost two-thirds (254 500) of new kidney cancer cases are diagnosed in men. Approximately 70% of kidney cancers are clear cell renal cell carcinomas (ccRCC),2Gansler T. Fedewa S. Amin M.B. et al.Trends in reporting histological subtyping of renal cell carcinoma: association with cancer center type.Hum Pathol. 2018; 74: 99-108Google Scholar which typically metastasise to the lungs, liver and bone.3Chevrier S. Levine J.H. Zanotelli V.R.T. et al.An immune atlas of clear cell renal cell carcinoma.Cell. 2017; 169: 736-749.e718Google Scholar Other subtypes with an incidence ≥5% are papillary RCC and chromophobe RCC, with each of the remaining subtypes accounting for ≤1% of the total incidence.4Hsieh J.J. Purdue M.P. Signoretti S. et al.Renal cell carcinoma.Nat Rev Dis Primers. 2017; 3: 17009Google Scholar,5Shuch B. Amin A. Armstrong A.J. et al.Understanding pathologic variants of renal cell carcinoma: distilling therapeutic opportunities from biologic complexity.Eur Urol. 2015; 67: 85-97Google Scholar Because of the predominance of ccRCC, however, kidney cancer can be broadly classified into either ccRCC or non-ccRCC (nccRCC).The highest incidence rates of kidney cancer/RCC are found in Northern and Eastern Europe, North America, Australia and New Zealand and the lowest in Asia.6Patel A.R. Prasad S.M. et association of the with kidney cancer incidence and Urol. Scholar The incidence of kidney cancer however, and to in Asian A. et and mortality of kidney and in a of 2017; and for kidney Rev Urol. cancers in J 2015; Scholar of the incidence and mortality rates for kidney cancer in a total of kidney cancer cases in Asian in A. et and mortality of kidney and in a of 2017; Scholar with the highest of new cases in China new Japan new and India new Japan and Singapore were the Asian with the highest incidence rates and was the and incidence and mortality rates for kidney A. et and mortality of kidney and in a of 2017; Scholar and kidney and renal and the of and the of kidney a of J A. et of renal cell J Scholar Approximately of are with the most associated with B. et al.Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and for the treatment and management of patients with kidney cancer/RCC in published J. J. et guidelines on the management of renal cell carcinoma 2015; 3: S. et cancer J guidelines for and treatment of renal cell carcinoma J Cancer et consensus recommendations for treatment of clear cell renal Asian J Cancer Cancer Cancer Guidelines for of 2015; Guidelines Scholar and are for the of both and treatment with the aim of The European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with RCC published Clinical Practice B. et al.Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and Scholar and a was by the ESMO and the Singapore Society of Oncology (SSO) B. et al.Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and Scholar and the associated to T. to the ESMO Clinical Practice Guidelines on renal cell carcinoma on and for clear cell renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and Scholar be adapted for patients of Asian of the Society of Clinical Oncology (CSCO), the Society of Medical and Oncology (ISMPO), the Society of Medical Oncology (JSMO), the Society of Medical Oncology (KSMO), the Society and the Taiwan Oncology Society for a meeting on May 2021 to adapt the recent ESMO Clinical Practice B. et al.Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and Scholar and associated T. to the ESMO Clinical Practice Guidelines on renal cell carcinoma on and for clear cell renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and Scholar for in the management of Asian patients with the adapted guidelines the meeting by the of evidence of and consensus reached for each of the current ESMO Clinical Practice Guidelines and associated B. et al.Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and T. to the ESMO Clinical Practice Guidelines on renal cell carcinoma on and for clear cell renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and Scholar was in with the of ESMO procedures and was an by and of experts was from the the ESMO and experts from each of the oncological societies of India (ISMPO), Japan (JSMO), Korea (KSMO), Malaysia and Taiwan and from the oncological of China of the expert from the and were to on the recommendations with the experts from each of the Asian societies Of the voting experts were (CSCO), and and the was to or adapt each of the recommendations in the ESMO Clinical Practice B. et al.Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and Scholar The Asian experts were to or on the with the scientific of the and and of each of the ESMO recommendations in a a consensus was the Asian experts were to the of the the virtual meeting of voting in to the or of an adapted and the applicability The Society of of the guidelines for cell Scholar was to the and of each to the recommendations were in in a of the Asian recommendations and in the and as consensus was to when of experts a was the the Asian experts on the and of the recommendations for the diagnosis, treatment and follow-up of patients with RCC from the 2019 ESMO Clinical Practice Guidelines and associated B. et al.Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and T. to the ESMO Clinical Practice Guidelines on renal cell carcinoma on and for clear cell renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and Scholar These recommendations were in the and and of of and of in the was for and and consensus for and and and consensus for to the meeting and to a of new T. et for J B. et or for renal cell J et for J J. et for the treatment of patients with cell renal cell carcinoma and et of in patients with papillary renal cell carcinoma: The Scholar new recommendations from an of the ESMO guidelines to the for the treatment of T. 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IntroductionIn 2018, an estimated 18.1 million new cases of cancer were diagnosed and 9.6 million cancer-related deaths recorded, worldwide.1Bray F. Ferlay J. Soerjomataram I. et al.Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin. 2018; 68: 394-424Google Scholar Of these, kidney cancer accounted for 2.2% (403 262) of new cases of cancer across both sexes, and 1.8% (175 098) of cancer deaths.1Bray F. Ferlay J. Soerjomataram I. et al.Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin. 2018; 68: 394-424Google Scholar Significantly, almost two-thirds (254 500) of new kidney cancer cases are diagnosed in men. Approximately 70% of kidney cancers are clear cell renal cell carcinomas (ccRCC),2Gansler T. Fedewa S. Amin M.B. et al.Trends in reporting histological subtyping of renal cell carcinoma: association with cancer center type.Hum Pathol. 2018; 74: 99-108Google Scholar which typically metastasise to the lungs, liver and bone.3Chevrier S. Levine J.H. Zanotelli V.R.T. et al.An immune atlas of clear cell renal cell carcinoma.Cell. 2017; 169: 736-749.e718Google Scholar Other subtypes with an incidence ≥5% are papillary RCC and chromophobe RCC, with each of the remaining subtypes accounting for ≤1% of the total incidence.4Hsieh J.J. Purdue M.P. Signoretti S. et al.Renal cell carcinoma.Nat Rev Dis Primers. 2017; 3: 17009Google Scholar,5Shuch B. Amin A. Armstrong A.J. et al.Understanding pathologic variants of renal cell carcinoma: distilling therapeutic opportunities from biologic complexity.Eur Urol. 2015; 67: 85-97Google Scholar Because of the predominance of ccRCC, however, kidney cancer can be broadly classified into either ccRCC or non-ccRCC (nccRCC).The highest incidence rates of kidney cancer/RCC are found in Northern and Eastern Europe, North America, Australia and New Zealand and the lowest in Asia.6Patel A.R. Prasad S.M. et association of the with kidney cancer incidence and Urol. Scholar The incidence of kidney cancer however, and to in Asian A. et and mortality of kidney and in a of 2017; and for kidney Rev Urol. cancers in J 2015; Scholar of the incidence and mortality rates for kidney cancer in a total of kidney cancer cases in Asian in A. et and mortality of kidney and in a of 2017; Scholar with the highest of new cases in China new Japan new and India new Japan and Singapore were the Asian with the highest incidence rates and was the and incidence and mortality rates for kidney A. et and mortality of kidney and in a of 2017; Scholar and kidney and renal and the of and the of kidney a of J A. et of renal cell J Scholar Approximately of are with the most associated with B. et al.Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and for the treatment and management of patients with kidney cancer/RCC in published J. J. et guidelines on the management of renal cell carcinoma 2015; 3: S. et cancer J guidelines for and treatment of renal cell carcinoma J Cancer et consensus recommendations for treatment of clear cell renal Asian J Cancer Cancer Cancer Guidelines for of 2015; Guidelines Scholar and are for the of both and treatment with the aim of The European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with RCC published Clinical Practice B. et al.Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and Scholar and a was by the ESMO and the Singapore Society of Oncology (SSO) B. et al.Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and Scholar and the associated to T. to the ESMO Clinical Practice Guidelines on renal cell carcinoma on and for clear cell renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and Scholar be adapted for patients of Asian of the Society of Clinical Oncology (CSCO), the Society of Medical and Oncology (ISMPO), the Society of Medical Oncology (JSMO), the Society of Medical Oncology (KSMO), the Society and the Taiwan Oncology Society for a meeting on May 2021 to adapt the recent ESMO Clinical Practice B. et al.Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and Scholar and associated T. to the ESMO Clinical Practice Guidelines on renal cell carcinoma on and for clear cell renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and Scholar for in the management of Asian patients with the adapted guidelines the meeting by the of evidence of and consensus reached for each

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