Abstract
In recent decade, there has been an extensive development in the systemic treatment of metastatic renal cell carcinoma (mRCC) with many targeted drugs being consecutively introduced into clinical practice. Tyrosine kinase inhibitors such as sunitinib, sorafenib, axitinib, pazopanib and cabozantinib are established drugs in the treatment of mRCC (especially in the first-line and second-line therapy), however, the use of mTOR inhibitors is shrinking due to their limited efficacy.
On the contrary, the use of immunotherapy is becoming more widespread, both in monotherapy as well as in combination (with targeted drugs or another immunotherapy). When choosing the most appropriate treatment, it is necessary to consider the characteristics of the patient and the disease and to take into account the toxicity profile of individual drugs.
With all that it is necessary to respect the reimbursement. It is also important to think of the next line of therapy - in this context there are still data lacking on the treatment with tyrosine kinase inhibitors after the failure of immunotherapy.