How to Manage Oligometastatic Kidney Cancer? Insights From IKCS 2025

In the latest episode of Oncology Decoded, hosts Manojkumar Bupathi, MD, MS, and Benjamin Garmezy, MD, broke down the treatment decision-making process for patients who present with oligometastatic kidney cancer. The experts zeroed in on this topic following their attendance at the 2025 International Kidney Cancer Symposium (IKCS), which featured a variety of sessions discussing the oligometastatic treatment setting.

The conversation opened with an aim to better define what oligometastatic disease constitutes for patients. Bupathi noted how patients can present with synchronous, metachronous, or oligoprogressive cancer based on when metastases appear around the time of diagnosis. Furthermore, the specific nature of a patient’s metastases may influence their treatment course. For example, in the case of a patient with de novo metastatic clear cell disease and lung metastases, Bupathi recommended the use of systemic therapy followed by cytoreduction, and the possibility of nephrectomy plus stereotactic body radiotherapy directed to the metastases.

Garmezy also emphasized distinguishing between de novo and recurrent disease, as both types necessitate the development of different treatment goals. For patients with recurrent oligometastatic disease, the primary goal of therapy may entail increasing the cure rate or extending treatment-free survival, depending on individual circumstances. Moreover, specific patient factors may influence the decision on whether to combine immunotherapy with radiotherapy.

In terms of standardizing a therapeutic approach for patients who present with oligometastatic disease, the hosts stressed the importance of strengthening efforts across multidisciplinary clinics and collaborating with radiology colleagues to better identify which sites of metastasis are progressing in patients.

Bupathi is an executive cochair of the Genitourinary Cancer Research Executive Committee at Sarah Cannon Research Institute (SCRI) and a medical oncologist with Rocky Mountain Cancer Centers, specializing in solid tumors and genitourinary cancers. Garmezy is the associate director of genitourinary research, an executive cochair of the Genitourinary Cancer Research Executive Committee at SCRI, and a medical oncologist at SCRI Oncology Partners specializing in genitourinary cancers.