Advances in the management of renal cell carcinoma

Renal cell carcinoma (RCC) is the most common form of kidney cancer, with 435 000 patients newly diagnosed worldwide each year. In addition to morphology and histology, molecular subtyping has advanced the diagnostic classification of RCC. Contemporary diagnosis relies on cross sectional imaging in the form of computed tomography or magnetic resonance imaging and selective biopsy. For localised disease, nephrectomy remains the standard of care, with partial nephrectomy being an option for smaller tumours. Ablation or stereotactic radiation is appropriate for selected patients. Adjuvant pembrolizumab provides improved disease-free and overall survival in high risk clear cell RCC. In metastatic disease, the introduction of immune checkpoint inhibitor based combinations has extended overall survival, providing a durable response in some patients. Despite these advances, primary and secondary resistance, along with the lack of predictive and prognostic biomarkers, remain a challenge.