Abstract
Summary: Renal cell carcinoma (RCC) is a heterogeneous group of tumors with different genetic and metabolic traits. They are among the richly vascularized and immunogenic tumors.
Since 2006, vascular endothelial growth factor receptor (VEGFR) tyrosine kinase (TKI) inhibitors have been the standard for first-line treatment of clear cell renal cell carcinoma (ccRCC). Based on the results of recently published studies, there are changes in the international gudelines NCCN and EAU (European Urological Society).
The immune checkpoint (CPI) inhibitors anti-PD-1 and anti-PD-L1 in combination with TKI are already included in the first line of ccRCC treatment. In the light of the new treatment regimens, the indication for cytoreductive nephrectomy (CN) is ambiguous.
The prediction of a CPI response based on anti-PD-L1 levels is currently highly questionable in the choice of immunotherapy.