(UroToday.com) The Society of Urologic Oncology (SUO) 2021 annual meeting in Orlando, FL was host to an excellent overview by Dr. Maria Carlo, MD of the future of genomic evaluation to direct therapy in renal cell carcinoma (RCC). Dr. Carlo began her presentation by defining genomic biomarkers in cancer as: “A measurable DNA or RNA characteristic that is an indicator of normal biologic processes, pathogenic processes, or response to therapeutic or other interventions”. The role of targetable biomarkers has been best defined in the non-small cell lung cancer disease space with multiple actionable targets currently present. In bladder cancer, Erdafitinib is being used to selectively target FGFR3 or FGFR2 altered metastatic clones and poly (ADP-ribose) polymerase (PARP) inhibitors have become featured in the management of select prostate cancer patients with DNA damage repair gene alterations. There is a paucity of genomic biomarkers in RCC due to the presence of few actionable somatic mutations with very rare kinase fusions.