The therapeutic landscape for renal cell carcinoma (RCC) and urinary tract cancer (UTC) has transformed dramatically, creating complexity in treatment selection and sequencing. The 2025 Advanced Urologic Cancer Consensus Conference was convened to establish evidence-based expert consensus recommendations for optimal management. A multidisciplinary panel of 51 experts participated in a modified Delphi process addressing questions developed through iterative consensus-building covering RCC and UTC management. Voting occurred before and after the conference, and analyses focused on postmeeting responses. Consensus was defined as ≥75% agreement, with strong consensus as >90%. Strong consensus was found on the use of adjuvant pembrolizumab for higher risk RCC (pathologic T2 [pT2], grade 4; pT3-pT4, any grade; pTXN1; or fully resected metastatic disease) and on neoadjuvant therapy before cystectomy for localized UTC. There was strong consensus on the use of enfortumab vedotin plus pembrolizumab as frontline therapy for metastatic UTC and the use of platinum-based chemotherapy postprogression in biomarker-negative UTC. For RCC, there was consensus on the role of single-agent vascular endothelial growth factor receptor-tyrosine kinase inhibitor therapy after progression on frontline immune checkpoint inhibitor/vascular endothelial growth factor receptor-tyrosine kinase inhibitor therapy or dual immune checkpoint inhibitor therapy. However, there was a lack of consensus on other critical areas in the management of RCC and UTC. The 2025 Advanced Urologic Cancer Consensus Conference provides evidence-informed guidance for complex clinical scenarios while identifying critical research priorities. The group recognizes that the lack of consensus across multiple areas highlights the need for improved patient selection and prospective studies enabling optimal combination and sequencing approaches. This iterative annual process will address evolving treatment paradigms to optimize outcomes.
CA: a cancer journal for clinicians. 2026 Jan [Epub]
Rana R McKay, Sumanta Pal, Wanling Xie, David Aggen, Laurence Albiges, Andrea Apolo, Michael B Atkins, Rick Bangs, Kathryn E Beckermann, Joaquim Bellmunt, Stephanie A Berg, Mehmet A Bilen, David Braun, Maria I Carlo, Jason Efstathiou, Matthew Galsky, Petros Grivas, Shilpa Gupta, Naomi Haas, A Ari Hakimi, Hans Hammers, Daniel Y C Heng, Michelle Hirsch, Gopakumar Iyer, Eric Jonasch, Vadim S Koshkin, Oleksandr Kryvenko, Bryan Lewis, Roger Li, Surena Matin, Benjamin Maughan, David F McDermott, Bradley McGregor, Joshua Meeks, Matthew Milowsky, Robert Motzer, Andrea Necchi, Dan Petrylak, Sima Porten, Thomas Powles, Brian Rini, Brian Shuch, Arlene Siefker-Radtke, Guru Sonpavde, S Srikala Sridhar, Cristina Suarez, Chad Tang, Abhishek Tripathi, Michiel S Van Der Heijden, Martin Voss, Wenxin Xu, Tian Zhang, Jonathan Rosenberg, Toni K Choueiri
Department of Medicine, Urology, and Radiation Medicine and Applied Sciences, University of California-San Diego, La Jolla, California, USA., Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California, USA., Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA., Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Department of Medical Oncology, Gustave Roussy, Villejuif, France., Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA., Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA., Bladder Cancer Advocacy Network, Bethesda, Maryland, USA., Department of Medicine, Tennessee Oncology, Nashville, Tennessee, USA., Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA., Section of Medical Oncology, Department of Medicine, Yale Cancer Center, Yale University, New Haven, Connecticut, USA., Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA., Division of Hematology and Medical Oncology, Department of Medicine, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA., Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA., Division of Hematology-Oncology, Department of Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA., Division of Hematology-Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA., Department of Medical Oncology, Tom Baker Cancer Center, University of Calgary, Calgary, Alberta, Canada., Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA., Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Division of Hematology/Oncology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA., Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA., KidneyCan, Philadelphia, Pennsylvania, USA., Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA., Division of Medical Oncology, Department of Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA., Division of Medical Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA., Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Division of Medical Oncology, Department of Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA., Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milan, Milan, Italy., Department of Medical Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK., Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee, USA., Department of Urology, University of California-Los Angeles, Los Angeles, California, USA., Department of Genitourinary Oncology, AdventHealth Cancer Institute, Orlando, Florida, USA., Division of Medical Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada., Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Hospital Universitari Vall d'Hebron, Barcelona, Spain., Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands.