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Opinion|Videos|March 31, 2026

First-Line Treatment Selection in Advanced Renal Cell Carcinoma

Author(s)Moshe Ornstein, MD, MA, Adam Singer, MD, Terence W. Friedlander, MD

Fact checked by: Justin Mancini

In this opening segment on advanced renal cell carcinoma, Ornstein introduces the evolving frontline treatment landscape, highlighting the expanded role of immune checkpoint inhibitor–based combinations and VEGF receptor–targeted therapies.

Episodes in this series

Experts featured in this series.

EP. 1 First-Line Treatment Selection in Advanced Renal Cell Carcinoma

Experts featured in this series.

EP. 2 Frontline Regimen Selection in Advanced Renal Cell Carcinoma

Experts featured in this series.

EP. 3 Impact of Sequencing on First-Line Decisions in Advanced Renal Cell Carcinoma

Experts featured in this series.

EP. 4 Real-World Treatment Attrition in Advanced Renal Cell Carcinoma

Experts featured in this series.

EP. 5 Managing Tolerability and Dose Optimization in Advanced Renal Cell Carcinoma

Experts featured in this series.

EP. 6 Second-Line Treatment Decision-Making in Advanced Renal Cell Carcinoma

In this opening segment on advanced renal cell carcinoma (RCC), Moshe Ornstein, MD, MA, introduces the evolving frontline treatment landscape, highlighting the expanded role of immune checkpoint inhibitor–based combinations and VEGF receptor–targeted therapies. He underscores the importance of selecting the most appropriate initial regimen, given the potential for durable benefit in the first-line setting.

Adam Singer, MD, PhD, outlines his clinical approach to first-line treatment selection, emphasizing the role of International Metastatic RCC Database Consortium risk stratification, disease burden, and patient-specific factors such as comorbidities and performance status. He also discusses how disease kinetics and the need for rapid response can influence regimen choice. The discussion reflects a practical, individualized approach to decision-making, balancing efficacy and tolerability while considering how up-front treatment choices may affect overall outcomes. This segment establishes the foundation for clinical management in advanced RCC.

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