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Table 2 Current updated front line treatment for mRCC based on the IMDC prognostic score risk factors

From: Determinants of resistance to VEGF-TKI and immune checkpoint inhibitors in metastatic renal cell carcinoma

Front line therapy Limited Disease Burden/ asymptomatic Substantial disease burden/ symptomatic
IMDC risk
 Good/Favourable risk Pazopaniba Nivolumabb plus ipilimumabc
Sunitiniba Pembrolizumabb plus axitiniba
  Avelumabd plus axitinib
 Intermediate and poor risk Nivolumabb plus ipilimumabc
Pembrolizumabb plus axitiniba
PD1/PD-L1 immune checkpoint inhibitor contraindications
Pazopaniba, Sunitiniba, Cabozantiniba
  1. aVEGFR-TKI, bAnti-PD-1 antibody, cAnti-CTLA-4 antibody, dAnti-PD-L1