Long-term management of patients with metastatic renal cell carcinoma on targeted agents.

Therapy for patients with metastatic renal cell carcinoma is becoming increasingly effective. Sustained partial remissions, occasional complete responses and manageable quality of life are seen in a subset of individuals. As we face the prospect of generating an increasingly large number of patients requiring long-term management, the choice and timing of systemic therapy and surgical interventions is becoming increasingly important. In this article, we review the timing and type of cytoreductive nephrectomy, what to do for patients with oligometastatic disease and how to deal with complete responders. In addition, we summarize the major side effects experienced with the commonly used molecularly targeted agents, and provide guidance on how to maximize benefit from these agents while maintaining an acceptable quality of life for patients. As treatment efficacy improves, the optimal integration of systemic therapy, surgery and toxicity management will become a critical aspect of our care for patients with metastatic renal cell carcinoma.