Multidisciplinary management of metastatic renal cell carcinoma: a narrative review
Year: 2026
Type: review
Abstract: Background and Objective: Metastatic renal cell carcinoma (mRCC) has historically been associated with poor oncologic outcomes and limited therapeutic options. However, over the past two decades, the mRCC treatment landscape has evolved considerably with the introduction of targeted therapies, delivered either in isolation or in combination with local therapies. This narrative review aims to summarize current evidence for the management of mRCC, with a particular focus on the role of local therapy after systemic therapy. Methods: Relevant articles were found by querying the PubMed database using various combinations of the keywords "Metastasis", "Renal Cell Carcinoma", "Systemic Therapy", and "Immunotherapy". Original research studies, systematic reviews, and meta-analyses providing current evidence for the management of mRCC or describing the role of local therapy after systemic therapy in mRCC were included; non-English language studies were excluded. Key Content and Findings: The systemic therapy landscape for mRCC is dominated by immuno-oncology (I/O)/IO combination therapy, IO/tyrosine kinase inhibitor (TKI) combination therapy, and TKI monotherapy. Local therapy before or after systemic therapy has an important role in mRCC management. Cytoreductive nephrectomy (CN), either upfront (before systemic therapy) or deferred (after systemic therapy), is widely used as a local treatment at the primary tumor site. Meanwhile, local treatment strategies implemented at the metastatic site(s), typically after systemic therapy, include metastasectomy, stereotactic radiotherapy, and thermal ablation. Given the vast modern landscape but heterogeneous response of mRCC treatment strategies, clinical decision-making in the management of this disease is increasingly being guided by risk stratification, biomarkers, multidisciplinary deliberations, and quality of life (QoL) considerations. Conclusions: mRCC management requires individualized care, shared decision-making, and multidisciplinary approaches that integrate oncologic outcomes with patient QoL. Ongoing clinical trials and future research should prioritize the identification of biomarkers to improve patient selection, optimize treatment strategies, and minimize morbidity and toxicity to enhance patient outcomes.
Institution: City Of Hope National Medical Center
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223808407