(UroToday.com) The treatment landscape for first-line therapy among patients with metastatic renal cell carcinoma (mRCC) has changed dramatically over the past 2 years. In 2018, the publication of the CheckMate214 data demonstrated a survival benefit for patients treated with nivolumab and ipilimumab compared with sunitinib in intermediate and poor-risk mRCC, ushering in the immunotherapy era for mRCC. The subsequent publication of the JAVELIN Renal 101, KEYNOTE-426, and CheckMate-9ER studies demonstrated the superiority of avelumab and axitinib, pembrolizumab, and axitinib, and nivolumab and cabozantinib compared to sunitinib in this disease space. Recently, lenvatinib and everolimus demonstrated prolonged progression-free survival, compared to everolimus, in the second-line setting, and lenvatinib and pembrolizumab have shown promise in a phase I/II setting. In a plenary abstract presentation in the Oral Abstract Session: Renal Cell Cancer session at the 2021 ASCO GU Cancers Symposium, Dr. Robert Motzer and colleagues describe the results of the CLEAR study examining first-line lenvatinib and everolimus or lenvatinib and pembrolizumab versus sunitinib in patients with advanced RCC. Concurrent with the presentation, CLEAR was published in the New England Journal of Medicine.1