Metastatic Kidney Cancer Medications

Page updated Winter 2021.

Disclaimer: Medicine is an ever-changing science. We have been witnessing changes in diagnostic and therapeutic modalities and guidelines during last several years. We have used sources believe to be reliable for purpose of this website including AUA guidelines, EAU guidelines, NCCN guidelines, Campbell-Walsh-Wein Urology, UpToDate, Merck Manual, Lexi-Comp, FDA website, and other reputable sources. However, due to possibility of human error or changes in medicine, readers are required to confirm the information provided in this website with other sources. Readers are specially required to read all parts of the product information sheet included in the package of each drug they plan to administer and follow those instructions. Readers are also needed to follow instructions of FDA and other regulatory bodies and their own department in this regard. Authors can cite information provided in our textbooks or they need to cite the original sources. This website serves as a general framework. We and other users would adjust the approach per departments policies and patients situation. Forms can be used by other health care professionals.

Cytoreductive Nephrectomy


Favorable risk patients: Early nephrectomy


Intermediate risk patients: Primary systemic therapy and delayed nephrectomy.


Poor risk patients: Nephrectomy is not advised

To determine the patient's risk group, click here.

Systemic Treatment for Clear Cell Histology


Favorable risk group:


Pembrolizumab (targeting PD-1)+ Axitinib (TKI)


Pazopanib (TKI), Sunitinib (TKI)


Intermediate and poor risk groups

Pembrolizumab plus Axitinib


Ipilimumab (targeting CTLA-4)+Nivolumab (targeting PD-1)


Cabozantinib (TKI)

Checkpoint Inhibitors Targeting PD-1

Pembrolizumab (Keytruda)


Pembrolizumab 200 mg IV q3Weeks OR 400 mg q6 weeks until disease progression, unacceptable toxicity, or up to 24 months without disease progression. It is given in combination with Axitinib.


Nivolumab (Opdivo)


Nivolumab 3 mg/kg IV q3Weeks


In combination with Ipilimumab. Should be given on the same day.


After completing 4 doses of combination therapy, give nivolumab 240 mg IV every 2 weeks or 480 mg IV every 4 weeks.


Checkpoint Inhibitors Targeting CTLA-4

Ipilimumab (Yervoy)


1 mg/kg IV q3Weeks


After completing 4 doses of combination therapy with nivolumab, just continue nivolumab.


VEGF Receptor Tyrosine Kinase Inhibitors


Axitinib (Inlyta)


5 mg PO BID (initial dose)


When it is used in combination with pembrolizumab, dose escalation above the initial 5 mg dose may be considered at intervals of six weeks or longer.


Pazopanib (Votrient)


800 mg PO daily on empty stomach


Sunitinib (Sutent)


50 mg PO daily for 4 weeks, then 2 weeks drug-free, then repeat the cycle.


Cabozantinib (Cometriq)


When used as a single agent: 60 mg PO daily