Treatment of Metastatic Renal Cell Carcinoma: A Comprehensive Review and Indian Perspective

Renal cell carcinoma (RCC) is the eighth most common type of cancer, with more than one-third of patients having metastases when first diagnosed. There is a paradigm shift in metastatic RCC (mRCC) management with the advent of newer therapy options. The development of new innovative diagnostic and therapeutic tools has improved the prognosis of patients with advanced-stage disease. Inclusion of agents targeting the vascular endothelial growth factor (VEGF) pathway (predominantly VEGFR-directed tyrosine kinase inhibitors (TKIs)), immune-checkpoint inhibitors (ICIs) and parallel efforts to uncover new targets unveil the underlying biological differences between heterogeneous disease subtypes. Thus, new systemic therapies have become increasingly complex and optimising patient selection and treatment sequence for better patient outcomes has become crucial. This review provides a comprehensive overview of advances in the treatment landscape, emphasising the importance of individualised treatment approaches for specific subgroups of patients and also discusses the Indian perspective on the management of metastatic renal cell carcinoma with real-world case studies.