Targeted therapy and immunotherapy have improved survival outcomes for patients with metastatic renal cell carcinoma. ESMO, NCCN and Czech society for oncology provide some guidelines for the most appropriate first-, secondand third-line treatment.
With the growing number of available therapeutic agents and improved survival, the optimal treatment patterns in fourth-line therapy need to be examined. No robust evidence exists to optimize treatment selection in this setting.
The fourth-line therapy varies significantly amongst different centers and jurisdictions.