TY - JOUR AU - Berg, Stephanie AU - Angel, Martin AU - Beckermann, Kathryn E. AU - Donskov, Frede AU - Lee, Chung-Han AU - Msaouel, Pavlos AU - McKay, Rana R. AU - Zhang, Tian PY - 2022/11/15 Y2 - 2024/03/28 TI - Therapies in Refractory Metastatic Renal Cell Carcinoma JF - Société Internationale d'Urologie Journal JA - Soc Int Urol J VL - 3 IS - 6 SE - 2022 WUOF/SIU International Consultation on Urological Diseases DO - 10.48083/KGTQ6832 UR - https://siuj.org/index.php/siuj/article/view/223 SP - 477-483 AB - As the therapeutic landscape for metastatic clear cell renal cell carcinoma (mccRCC) expands to include vascularendothelial growth factor receptor tyrosine kinase inhibitors (VEGFR TKIs) and immunotherapies, new challengesare in place for evaluating and treating refractory disease. Assessing and managing refractory disease has severalelements: (1) the mechanism(s) of front-line treatment, (2) timing of progressive disease, (3) rapidity and sites ofprogressing disease, (4) use of adjuvant therapy, and (5) incorporation of surgical and radiation techniques. Thesevariables all have distinct impact on the biology of refractory or resistant mccRCC. A better understanding ofthe essential mechanisms of both primary and secondary immunotherapy resistance will inform biomarkerdevelopment and therapeutic strategies in the refractory setting. This paper addresses the current understandingof treatment sequencing in refractory mccRCC, focusing on treatment options with prospective clinical trial data,considers refractory mccRCC after adjuvant immunotherapy, and incorporates radiation or surgical resection foroligoprogressive disease. ER -