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RCC — SCE Medical Oncology MCQ

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HardUrological CancersRCCSCE Medical Oncology

A patient has untreated metastatic clear-cell renal carcinoma. Karnofsky performance status is 70%, haemoglobin is below the lower limit of normal and the interval from diagnosis to systemic treatment is 8 months; calcium, neutrophils and platelets are normal. Which NICE-funded regimen is specifically restricted to the resulting IMDC category?

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Correct answer: B — Nivolumab plus ipilimumab, as three IMDC factors define the poor-risk category

Karnofsky below 80%, haemoglobin below normal and diagnosis-to-treatment under 1 year give three IMDC factors, which is poor risk. TA780 recommends nivolumab plus ipilimumab for untreated advanced RCC of intermediate or poor IMDC risk. The appraisal does not require PD-L1 testing. Nivolumab monotherapy is not substituted in untreated disease, and poor risk supports prompt systemic treatment rather than surveillance.

Reference: NICE TA780 nivolumab with ipilimumab for untreated advanced renal cell carcinoma (Published March 2022): https://www.nice.org.uk/guidance/ta780/chapter/1-Recommendations