Modern treatment of kidney cancer

The introduction of immune checkpoint inhibitor combinations has opened a new era in the treatment of metastatic clear cell renal cell carcinoma. VEGF tyrosine kinase inhibitor monotherapy has gradually been replaced in the first-line setting by immune-based combination therapies providing significant overall survival benefit and higher complete response rates. Current first-line standards include ipilimumab+nivolumab, pembrolizumab+axitinib, nivolumab+cabozantinib, and pembrolizumab+lenvatinib combinations.

Treatment selection is influenced not only by IMDC risk classification but also by the biological behavior of the disease, disease dynamics, symptoms, comorbidities, and patient preference. The introduction of adjuvant pembrolizumab creates a novel clinical scenario, while the optimal management of relapse following immunotherapy remains unclear.

In later treatment lines, cabozantinib, lenvatinib+everolimus, nivolumab, and the HIF-2α inhibitor belzutifan represent important therapeutic options. This review summarizes current standards in the treatment of metastatic clear cell renal cell carcinoma, with special focus on treatment strategy selection.