GENITOURINARY SYSTEM: Edited by Arif HussainChallenges and opportunities in the management of metastatic renal cell carcinoma: combination therapy and the role of cytoreductive surgeryPatel, Hiren V.a; Shinder, Briana; Srinivasan, Ramaprasadb; Singer, Eric A.aAuthor Information aSection of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey bUrologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA Correspondence to Eric A. Singer, MD, MA, MS, FACS, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, Room 4563, New Brunswick, NJ 08903, USA. E-mail: firstname.lastname@example.org Current Opinion in Oncology: May 2020 - Volume 32 - Issue 3 - p 240-249 doi: 10.1097/CCO.0000000000000621 Buy Metrics Abstract Purpose of review As the biology of metastatic renal cell carcinoma (mRCC) continues to be elucidated, novel treatments focused around immunotherapies and targeted therapies will continue to emerge. In this review, we will highlight recent treatment advances and their implications for surgical and systemic therapy. Recent findings Several new treatments, including the tyrosine kinase inhibitor cabozantinib, the combination of a programmed cell death protein 1 antibody (nivolumab) with a cytotoxic T-lymphocyte-associated antigen 4 antibody (ipilimumab), and the combination of axitinib with pembrolizumab or avelumab have been approved by the US Food and Drug Administration as first-line therapy for the treatment of mRCC. Although promising survival benefits have been seen with these new therapies, careful patient selection is still critical. Summary The introduction of novel therapies and the investigation of combinatorial therapies have shifted the treatment paradigm for advanced RCC. Present trials have provided promising data that could lead to further therapeutic advances. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.