| Evolent Pathways | Febrile Neutropenic Risk | Emetogenic Risk | References | ||
|---|---|---|---|---|---|
| ADVANCED/METASTATIC - CLEAR CELL HISTOLOGY | |||||
Initial Therapy |
axitinib and pembrolizumab *Favorable Risk Disease* |
Low | Moderate |
|
|
lenvatinib and pembrolizumab *Favorable, Intermediate or Poor-Risk Disease* |
Low | High |
|
||
nivolumab with or without ipilimumab *Intermediate or Poor-Risk Disease followed by continuation of nivolumab* |
Low | Low |
|
||
Subsequent Therapy |
cabozantinib |
Low | Low |
|
|
pazopanib |
Low | Low |
|
||
nivolumab |
Low | Low |
|
||
Best Supportive Care or Clinical Trial |
Not Applicable | Not applicable |
|
||
Initial Therapy
axitinib and pembrolizumab *Favorable Risk Disease*
lenvatinib and pembrolizumab *Favorable, Intermediate or Poor-Risk Disease*
nivolumab with or without ipilimumab *Intermediate or Poor-Risk Disease followed by continuation of nivolumab*
Subsequent Therapy
cabozantinib
pazopanib
nivolumab
Best Supportive Care or Clinical Trial
| Regimen | Alternative | References | |||
|---|---|---|---|---|---|
| LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES | |||||
Initial Therapy |
** cabozantinib or axitinib ** favorable risk |
Alternative: pazopanib |
|||
Initial Therapy |
** axitinib ** poor/intermediate risk |
Alternative: axitinib and pembrolizumab, pazopanib |
|||
Subsequent Therapy |
** axitinib and avelumab ** |
Alternative: nivolumab or cabozantinib |
|||
Subsequent Therapy |
** bevacizumab or sorafenib ** |
Alternative: nivolumab or cabozantinib |
|||
Initial Therapy
** cabozantinib or axitinib ** favorable risk
Initial Therapy
** axitinib ** poor/intermediate risk
Subsequent Therapy
** axitinib and avelumab **
Subsequent Therapy
** bevacizumab or sorafenib **