OBJECTIVES: Of 431,288 new kidney cancer cases worldwide in 2020, AP has the highest incidence (~36% of all cases). RCC accounts for ~85% of all kidney neoplasms. This SLR summarizes AP evidence about patient characteristics and TP in RCC.

METHODS: Embase^®, Medline^®, and relevant congresses were searched for observational studies and clinical guidelines in advanced/metastatic or adjuvant RCC in AP. For the TP review, only systemic therapies were included. English language records published during 2016–2021 were included (2019–2021 for congresses).

RESULTS: Of the 1,008 records obtained, 9 studies and 3 guidelines were included. Seven studies reported TP: 5 in metastatic (m)RCC (1L/2L), and 2 in adjuvant RCC. The most common class of 1L mRCC treatments was tyrosine kinase inhibitors (TKI)—mostly sunitinib (40.6–100%). Everolimus (13.2–85.2%) and axitinib (2–89%) were the most used 2L treatments in mRCC or unresectable/mRCC, respectively. The few guidelines published between 2016–2019 on adjuvant/advanced RCC made varied recommendations, and they reflected the evolving advanced RCC treatment landscape. The Indian Oncology Gold Standard expert group guidelines (2016) recommended 1L treatment of metastatic clear cell RCC (mccRCC) with a mammalian target of rapamycin inhibitor (mTORi), with everolimus being standard of care. The Hong Kong Urological Association/Hong Kong Society of Uro-oncology guidelines (2019) recommended immune-oncology (IO) for mccRCC following publication of phase 3 studies showing survival benefits with IO over sunitinib, or TKI if cost constrained. The Chinese National Health Commission guidelines (2018) recommended clinical trial enrollment as 1L for high-risk patients with ccRCC or TKI for low-risk patients. The Hong Kong guidelines recommended dose adjustment to manage TKI toxicities in Asian patients.

CONCLUSIONS: TKI/mTORi/IO are currently used to manage RCC, with TKIs being most used in 1L mRCC. Although the latest guideline suggested changing the paradigm towards IO-based regimens due to improved survival over sunitinib; this was not evident in the observational studies identified.