Dr. Brugarolas reflects on his lab's role in developing HIF-2 inhibitors and his ongoing work to improve patient outcomes. An exploratory analysis revealed a strong OS advantage associated with a PD-L1 combined positive score higher than 1. CA9 imaging and ZIRCON data offer new insight into managing small renal masses and supporting personalized kidney cancer care Drs. Joyce and Chang discuss diagnostic strategies and future innovations in managing small renal masses. Drs. Beckermann and Braun reflect on key lessons from the trial, emphasizing the importance of prioritizing driver mutations. Drs. Beckermann and Braun break down the selection process for neoantigens in the trial for personalized RCC vaccines. Drs. Beckermann and Braun discuss the latter's Nature publication on a personalized neoantigen vaccine for RCC. Patients with mRCC on Medicare have better survival rates compared with patients on Medicaid or with no insurance. A recent proof-of-concept study has further evaluated the efficacy of PSMA-guided MDT for oligometastatic RCC. The panel concludes with future directions in RCC, including HIF inhibitors and biomarker-guided adjuvant strategies. The panel considers how managing real-world patients on novel therapies like belzutifan presents a multitude of challenges. The panel explains how the approval of subcutaneous nivo offers advantages in patient convenience and healthcare efficiency. The panel weighs long-term treatment-free survival with nivo/ipi against the need for disease control with IO-TKI combos. The panel considers the limitations of ctDNA from low tumor shedding but expresses optimism for detection technology. The panel weighs the evolving role of biomarkers, particularly the promising blood-based biomarker KIM-1. The combination therapy provided similar survival rates and toxicity in an older patient population. Sequencing, novel therapies, and treatment combinations for refractory RCC are examined in part 5 of this discussion. The panel explores the evolving role of cytoreductive nephrectomy in RCC and how biomarkers shape treatment decisions. The panel discusses considerations for triplet therapy in RCC, new trial data, and biomarker-driven treatment strategies. In part 2, the panelists discuss adjuvant therapy for RCC, including biomarkers and optimizing treatment for better outcomes.