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. Part one of the discussion covers adjuvant therapy in kidney cancer, patient selection, and balancing risks and benefits. Dr. Daniel Joyce gives an overview of his study that examined the use of necrosis as a prognostic indicator for mRCC. Drs. Tawagi and Armstrong recap the hottest topics in kidney cancer research from the 2025 ASCO GU Cancers Symposium. PRO data suggest tivozanib monotherapy maintained quality of life in patients with RCC that progressed after ICI therapy. The findings from the substudy point to durable antitumor activity for the lenvatinib + belzutifan combination. Dr. Albiges details the final results of COSMIC-313, highlighting the effectiveness of cabo plus nivo/ipi for aRCC. Drs. Xu and Joyce break down the evaluation of circulating KIM-1 as a prognostic and predictive biomarker in advanced RCC. Previous data from the phase II CALYPSO study has demonstrated the efficacy of durvalumab in combination with savolitinib.