Authors' objectives: Renal cell carcinoma (RCC) is a cancer that usually originates in the lining of the tubules of the kidney (the smallest tubes inside the nephrons) that help filter the blood and make urine. RCC is the most common type of kidney cancer (approximately 90% of the cases).(1) There are several different types of RCC, with the main ones divided into 5 categories: clear cell, papillary (types 1 and 2), chromophobe, oncocytic and collecting duct carcinoma. Clear cell is the most common form of RCC accounting for approximately 80 90% of cases.(2) The tumour node metastases system is used to grade RCC into stages I to IV. Advanced RCC, in which the tumour is either locally advanced and/or has spread to regional lymph nodes, is generally defined as stage III. Metastatic RCC, in which the tumour has spread beyond the regional lymph nodes to other parts of the body, is generally defined as stage IV. Early, small RCC tumours are usually asymptomatic; the diagnosis of early RCC is usually incidental after abdominal scans for other indications. The most common presenting symptoms of metastatic and/or advanced RCC are blood in the urine (haematuria), a palpable mass in the flank or abdomen and abdominal pain. Other non-specific symptoms include fever, night sweats, malaise and weight loss. Nephron sparing surgery may be curative in people with localised tumours. However, around half of those who have curative resection for earlier stages of the disease develop advanced and/or metastatic disease later on. In 2013, 9,900 new kidney cancer cases were diagnosed in England.3 In 2013, approximately 46% of people diagnosed with kidney cancer had stage III or IV disease and 27% had stage IV disease.(3) The 5-year survival rate for metastatic RCC is approximately 10%.(4) The aim of treatment is to stop the growth of new blood vessels within the tumour. After failure of prior systemic treatment with a tyrosine kinase inhibitor or cytokine, NICE technology appraisal guidance 333 recommends axitinib. Because the remit referred to NICE by the Department of Health for axitinib only includes adults who have been previously treated with sunitinib, the use of axitinib after treatment with other tyrosine kinase inhibitors is not subject to statutory funding. Sorafenib, sunitinib and everolimus are not recommended after initial therapies have failed in NICE guidance (NICE technology appraisal guidance 178 and 219). Everolimus is available in England for metastatic RCC through the Cancer Drugs Fund (at the time the final scope was written) for people who have had prior treatment with only one previous tyrosine kinase inhibitor. Everolimus was available for second or third line treatment of metastatic renal cell carcinoma where disease has progressed on or after treatment with VEGF-targeted therapy through the Cancer Drugs Fund until November 2015 when it was removed from the Cancer Drugs Fund list. Everolimus is subject to ongoing NICE CDF transition review [ID1014]. An ongoing NICE technology appraisal is in development for nivolumab for previously treated advanced or metastatic RCC [ID853].

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hta/161009/#/

Year Published: 2017

URL for published report: https://www.nice.org.uk/guidance/ta463/resources

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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