Renal cell carcinoma is a common malignant tumour, whose incidence is steadily increasing. Whilst operative techniques have recently improved, including possibilities of renal preservation and minimally invasive surgery, no use has been shown for adjuvant treatment strategies. When local therapies are not suitable in relapsed or metastatic disease, medical drug treatment is indicated. The first immunologic treatment for renal cell carcinoma consisted of cytokines and overall survival amounted to a median of 13 months. Over the last decade, tyrosine kinase inhibitors (TKI), which inhibit the tumour vasculature, dominated the therapeutic area and raised the clinical discussion about the best sequential pattern. More recently, checkpoint inhibitors (CPI) have set a new standard as therapeutic tools in renal cell cancer. Modern first-line therapies consist of checkpoint inhibitor-based combinations, which have shifted the median overall survival expectation to >40 months. However, tyrosine kinase inhibitors have retained their therapeutic value as combination partners and also as monotherapy in individual cases. One combined immunotherapy and 3 combinations of a checkpoint inhibitor and a TKI are currently approved in Germany.
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