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The treatment armamentarium of metastatic renal cell carcinoma (mRCC) has evolved significantly in the last few years. The upfront use of single-agent tyrosine kinase inhibitors (TKIs) has been rendered obsolete with the introduction of immunotherapy in the frontline setting. In this new era, upfront cytoreductive nephrectomy is no longer the preferred strategy except in some select cases with symptomatic primary tumors or low volume metastases.

Risk stratification using the International mRCC Database Consortium Prognostic Model score remains key in determining the optimal frontline therapeutic approach in mRCC patients. Immune checkpoint blockade, either as an immunotherapy doublet or in combination with TKIs has demonstrated an impressive rate of durable response -- even in patients with variant histology, fundamentally morphing our goal of treatment from palliation to cure for many patients.

In an article in the , Tenold et al. provide a comprehensive overview of the current treatment paradigm of mRCC, reviewing the pivotal trial data that led to new drug approvals for both front-line and refractory cases.

The authors further review special scenarios in mRCC management including the concepts of active surveillance and metastasectomy in patients with advanced disease.

Kriti Mittal, MD, MS, is an assistant professor in the Division of Hematology Oncology at the University of Massachusetts.

Read the study here and an interview about it here.