Renal cell cancer accounts 2-3 % of all cases of malignancy. Sunitinib and Pazopanib have so far been standard in first line treatment of metastatic renal cell cancer.
In this review we discuss current first-line treatment options as new tyrosine kinase inhibitor cabozantinib, the new combination of immunotherapy (nivolumab plus ipilimumab), and combination of immunotherapy and tyrosine kinase inhibitor. With the growing therapeutic options, identification of new biomarkers will be crucial for optimizing first-line selection.