Clinical Review on the Management of Metastatic Renal Cell Carcinoma

Jennifer Tran, DO; Moshe C. Ornstein, MD, MA


J Oncol Pract. 2022;18(3):187-196. 

In This Article

Abstract and Introduction


Renal cell carcinomas vary considerably in their tumor biology and disease course, which is reflected in the range of treatment paradigms in localized and metastatic renal cell carcinoma (mRCC). Active surveillance remains an important component of all renal cell carcinoma management. In mRCC, the rapid evolution from cytokine-based therapy to targeted therapy to immunotherapy with checkpoint blockade has revolutionized the field and drastically altered treatment outcomes. More recently, combination therapies have become a standard of care for most patients with mRCC. In this review, we highlight recent critical data that led to changes in treatment paradigms and provide a practical framework for the management of patients with mRCC.


Renal cell carcinoma (RCC) is the most common form of kidney cancer and accounts for close to 74,000 new cases annually in the United States.[1] Most patients present with localized disease amendable to surgical treatment with definitive intent. However, approximately one third of patients treated with curative intent will develop metastatic disease recurrence. Likewise, 30% of patients have metastatic disease at their initial presentation.[2]

Over the last two decades, the management of metastatic renal cell carcinoma (mRCC) has evolved from high-dose interleukin 2 (IL-2) and interferon-α to targeted therapies such as vascular endothelial growth factor receptor (VEGF-R) inhibitors, mammalian target of rapamycin (mTOR) inhibitors, and immunotherapy with checkpoint inhibitors. As a result, the median survival has improved from < 1 year in the 1990s to over 4 years in some recent trials.[3,4] In this review, we highlight clinically relevant data and provide a practical framework for the management of patients with mRCC.