(UroToday.com) The Realizing Potential Combination and Personalized Therapy educational session at the European Society of Medical Oncology’s (ESMO) 2021 congress included a presentation by Dr. Manuela Schmidinger discussing the current status of personalized therapy in metastatic RCC. Dr. Schmidinger notes that the reason we need personalized therapy in metastatic RCC is that there are currently four competing strategies for IMDC intermediate-poor risk patients and three options for favorable risk. Given the wealth of novel treatment options, multiple questions arise: (i) what is the role of single-agent TKI? In favorable-risk patients there is no OS advantage for single-agent TKI, however, the complete response rate is twice as high; (ii) If ICI-based therapies are the backbone, should we be offering ICI doublets or ICI/TKI combination therapy? (iii) If we are using ICI-only treatment, does it always mean it has to be a doublet? (iv) If ICI/TKI double therapy, which TKI should we use? (v) Do some patients need something totally different than the current clinical trials we have?