Genetic analysis of primary renal cell carcinoma to determine treatment approaches

Introduction: To date, there is no validated predictive biomarker available that guides treatment selection between an immune-based or an anti-VEGF-based regimen in patients with metastatic renal cell carcinoma (mRCC). Here, valid biomarkers could increase the benefit of therapy and thereby safe unnecessary toxicity. Recently, phase II and III clinical trials have shown a correlation between molecular clusters and responses to targeted therapy with tyrosine kinase inhibitors (TKIs), immune checkpoint inhibitors (ICIs) or as combination of both in patients with clear-cell mRCC. Areas covered: This review discusses recent advances in the discovery of predictive biomarkers, highlighting the growing role of genetic analysis for treatment selection and its potential impact on precision medicine in mRCC. In this context, we extensively analyzed the available literature from Pubmed's archives on this topic. Expert opinion: Molecular subclassification which predicts responses to TKI, or ICI therapy is an exciting step toward personalized medicine in mRCC, but this still requires validation. However, intratumoral heterogeneity in relationship to the predictive power of molecular analysis of the primary tumor and circulating tumor DNA is challenging and requires further analysis.