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ESMO E-Learning: Advances in Systemic Treatment of Advanced/Metastatic Renal Cell Carcinoma

Learning objectives

  • To provide an update on the role of nephrectomy and/or metastasectomy in the management of patients with advanced renal cell carcinoma (RCC)
  • To provide an update on 1st, 2nd and 3rd line of systemic therapy in advanced RCC
  • To provide an update on new agents and selected new combinations in the management of patients with advanced RCC
  • To provide an update on adjuvant  systemic therapy in patients with clear cell RCC


Renal cell carcinoma (RCC) is the 7th most common cancer in men, and the 9th most common cancer in women. In terms of histology, 85% or more tumours are clear cell RCC. Male/female ratio is 2/1. Smoking, obesity and hypertension are established risk factors. Median age at diagnosis is 65 years. Five-year survival has improved from 50.9% in a period from 1975 to 1977 to 70.6% in the period from 2002 to 2008. 

Unfortunately, because RCC is clinically silent for much of its natural history, many individuals present with unresectable disease, metastatic disease, or locally advanced RCC prone to recurrence. Surgery is not an option for cure in these individuals. Several other treatment options exist, but not all are effective. In particular, advanced RCC is extremely resistant to radiotherapy and chemotherapy. 

In the past several years the oncology community has seen a plethora of new targeted and immunotherapy drugs that have emerged into treatment of RCC patients. The therapeutic landscape has changed rapidly. This E-Learning module represents an update of a previous ESMO module in the RCC field. 

The first part of the module elaborates the value of metastasectomy and cytoreductive nephrectomy in patients with metastatic disease. The following chapter is dedicated to an overview of pivotal trials in the treatment of advanced disease. The authors elaborate the choice of targeted agent in first-line treatment, options for second-line treatment after failure of anti-VEGF, and how to make therapy decisions for third-line treatment. Furthermore, the authors elaborate new agents and selected new combinations. The last chapter is dedicated to the advances in the adjuvant treatment for clear cell RCC.

This E-Learning module is a good tool to keep abreast with standard of care for patients with RCC that has dramatically changed in an era of targeted therapy and immune-checkpoint inhibitors.

This E-Learning module was published in 2019 and expired in 2021.

Last update: 28 Feb 2019

Prof Bellmunt has reported the following:

  • Advisory role: Genentech, MSD, Pfizer, GSK, BMS, Pierre-­Fabre, Sanofi Aventis, Astellas, OncoGenex and Janssen.
  • Lectures fee (no speaker’s bureau): Pfizer, MSD, GSK, Novartis, Pierre-­Fabre and Astellas.
  • Research funding: Takeda, Pfizer, Novartis, Sanofi Aventis.

Dr Nadal has reported no conflicts of interest.

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