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2020年欧洲泌尿外科学会(EAU)肾癌指南中对于晚期和转移性肾癌系统治疗最大的更新亮点就是不再推荐酪氨酸激酶抑制剂如舒尼替尼、帕唑帕尼、卡博替尼等单药治疗作为转移性肾透明细胞癌的一线首选治疗方案，而免疫检查点抑制剂联合治疗成为这类患者一线治疗的首选，如帕博利珠单抗联合阿昔替尼和纳武单抗联合伊匹单抗，分子靶向药物仅作为无法接受或者不能耐受免疫治疗患者的一线治疗方案。而对于免疫检查点抑制剂联合治疗失败的患者，可选用靶向药物作为二线治疗方案。本文就2020年EAU肾癌指南中晚期和转移性肾癌系统治疗更新部分进行介绍并解读。

The highlight of the 2020 EAU guideline updates on the systemic therapy for advanced and metastatic renal cell carcinoma is that monotherapy tyrosine kinase inhibitors, e.g. sunitinib, pazopanib, cabozantinib are not recommended as fist line treatment option for clear-cell metastatic renal cell carcinoma. Instead, immune checkpoint inhibitor combination therapy becomes the first choice for these patients. However, the targeted therapies can be offered as second-line therapy to patients refractory to pembrolizumab plus axitinib or nivolumab plus ipilimumab.