- Management of advanced clear cell RCC is heavily based on systemic agents targeting the tumor stroma and immune microenvironment.
- VEGFR-directed TKIs remain the standard of care for first-line treatment of metastatic RCC. Results with multiple immuno-oncology–based combination regimens are challenging this concept in ongoing randomized trials.
- PD-1–directed therapy already has an established role in TKI-pretreated patients. Serial use of VEGF TKI–based treatments can be considered in the second line and later lines as well.
- While systemic therapy for this disease consists almost exclusively of molecularly targeted agents, predictive biomarkers that guide the choice of currently approved agents have not been established.