Developing an algorithm for the management of Renal Cell Carcinoma: focus on metastatic disease

The treatment paradigm in renal cell carcinoma (RCC) is rapidly changing. The incidental finding of small renal tumours combined with the development of novel therapeutic agents targeting the vascular endothelial growth factor (VEGF) or the mammalian target of rapamycin (mTOR) pathways or inhibiting the interaction of the programmed death 1 (PD 1) receptor with its ligand have dramatically improved the prognosis of patients suffering from this malignancy. At the same time, the availability of multiple effective options with similar indications complicates the development and applicability of guidelines in this disease. We conducted a systematic review of the existing guidelines. Our study revealed areas of agreement as well as of discrepancies amongst the published scientific papers included. By critically evaluating these areas, we developed a therapeutic algorithm for RCC. We suggest that this methodology can define the practices of wide applicability and areas of future research.