Risk-adapted (immuno)therapy for renal cell carcinoma

The introduction of immunotherapy into the therapeutic algorithm of metastatic renal cell carcinoma (mRCC) represents the most recent expansion of the therapy landscape. This provides anew therapeutic axis in addition to targeted therapies. At the same time, the development of new tyrosine kinase inhibitors (TKIs) has led to an improvement in the effectiveness of targeted therapies. Cabozantinib and tivozanib are two new first-line options that redefine the existing therapy algorithm. The importance of the checkpoint blockade in the first line is clinically undisputed; however, approval of the immune combination ipilimumab+nivolumab has not yet been granted. An important task now is to offer risk-adapted therapy in order to optimally balance efficacy and risks of systemic therapy, thereby ensuring the best possible individual therapy.