Hong Kong consensus statement updates management for locally advanced and metastatic renal cell carcinoma

BackgroundContinuous efforts have been made to optimise treatment approaches for renal cell carcinoma (RCC), including locally advanced (la)RCC and metastatic (m)RCC. To update their joint consensus statements on the management of la/mRCC, the Hong Kong Urological Association and the Hong Kong Society of Uro-Oncology convened a series of Delphi meetings.MethodsA panel of six urologists and eight clinical oncologists was formed, addressing five areas: (i) surgical and (neo)adjuvant treatment in laRCC; (ii) first-line management of clear cell mRCC; (iii) second- and later-line treatment of clear cell mRCC; (iv) management of mRCCs with sarcomatoid features or non-clear cell histology; and (v) management of oligometastatic RCC. Consensus statements were drafted based on an extensive literature review and panel discussions. A consensus statement was established only if ≥ 80% of the panellists selected ‘accept completely’ or ‘accept with some reservation’ from a five-point Likert scale through anonymous voting.ResultsA total of 42 consensus statements were accepted. Compared with the previous version, this set of consensus statements asserted the use of adjuvant therapy for laRCC and the use of immunotherapy-based combination therapy across different types of mRCC; multiple new areas were also added, including active surveillance in mRCC patients with very favourable prognosis, a novel therapeutic agent for mRCC (belzutifan), and the definitions and management of oligometastatic/oligoprogressive RCC.ConclusionWhile several research gaps remain to be addressed, this set of consensus statements reflects contemporary approaches for la/mRCC management, offering practical references for clinicians in Hong Kong and the Asia-Pacific region.