(UroToday.com) There have been transformational changes in first-line therapy for patients with metastatic renal cell carcinoma (mRCC) in the past three years. Foremost among these is the move from monotherapy to combination approaches. While CheckMate 214 first brought combination therapy with dual checkpoint inhibition (nivolumab and ipilimumab) to the forefront, subsequent studies have examined combinations of immune checkpoint inhibitors and tyrosine-kinase inhibitors in the first-line setting including pembrolizumab and axitinib. In the Kidney and Bladder Poster session at the 2021 American Society of Clinical Oncology Annual Meeting, Dr. Kevin Zarrabi presented real-world outcomes in patients treated with either axitinib and pembrolizumab or ipilimumab and nivolumab, stratified according to International Metastatic RCC Database Consortium (IMDC) score.