Two Onc Docs Metastatic Kidney Cancer x Uromigos 2025 UPDATES (Part 2)
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Aug 4, 2025 
Join oncologists Dr. Tom Powles and Dr. Brian Rini as they dive into the latest strategies for managing metastatic renal cell carcinoma. They discuss the importance of risk stratification and patient characteristics in treatment selection. The conversation covers the evolving role of cytoreductive nephrectomy, the significance of immunotherapy breaks, and the complexities of side effects from tyrosine kinase inhibitors. Listen for insights on tailored approaches for various RCC subtypes and career advice for budding oncologists!
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Clear Cell Status Is Crucial
- Determining whether a tumor has a clear cell component is the single most important test in metastatic RCC.
- IMDC and MSKCC give prognostic information but are not predictive biomarkers for therapy selection.
Be Selective With Cytoreductive Nephrectomy
- Use cytoreductive nephrectomy selectively and avoid it when it will delay systemic therapy or in patients with widespread aggressive disease.
- Consider surgery after systemic therapy for responders at specialized centers rather than reflexively upfront.
Offer IO+TKI For Favorable Risk
- For favorable-risk metastatic RCC, offer an IO+TKI combination as a standard option and discuss alternatives like ipilimumab+nivolumab per guidelines and licensing.
- Explain the licensing nuance and recent long-term data when counseling patients about ipilimumab+nivolumab.