The following questions and responses have been lightly edited for grammatical purposes. 

1) How far along is personalized or precision medicine in kidney cancer?

Dr. Choueiri: Precision medicine and personalized medicine are very broad terms. They can mean a lot of different things. If we’re talking about precision medicine in the academic sense, it means:
You have a drug that targets and kills the cancer completely without harming normal tissue. That’s happened in rare situations, but it’s uncommon.

If you mean personalized in a more practical sense, choosing the right treatment for this patient at this time so they can stay alive, functional, working, and spending time with loved ones—then yes, we’re very close. Honestly, I think we’re basically there. Treatment is not one-size-fits-all anymore.

2) What current or developing treatments that patients with advanced metastatic clear cell renal carcinoma should know about?

Dr. Toni Choueiri: HIF-2 inhibitors: we have one approved already, and others are coming. If they’re even slightly better or less toxic, that’s a win. 

Cellular therapies—CAR-T, NK cells—have shown toxicities, but we’re seeing some responses. We need to refine them. There’s a lot to think about, but they’re in development.

There’s also a class of drugs called bispecifics, where two key targets in kidney cancer, PD-1 and VEGF, are targeted together, maybe based on the tumor microenvironment. It’s not brand new, but giving the drugs in this combined way might improve efficacy and reduce side effects. Data from lung cancer looks promising, so we’ll see whether that holds up in kidney cancer. 

3) What are your thoughts on cancer vaccines and the future of kidney cancer care?

Dr. Choueiri: I’m excited about vaccines, though they’re incredibly hard to make. They’re individualized, expensive, and time-consuming. We ran a study that did extremely well and was published in Nature. Vaccines work best when there isn’t much cancer left. The immune system can kill hundreds of thousands of cells, but not billions.

There’s a lot happening. Many people are working on many approaches. There’s reason to be hopeful.

It might even be something simple: taking five active drugs, combining them at the right doses so they’re not too toxic—that’s how we’ve cured diseases like lymphoma, leukemia, HIV, hepatitis. Combination therapy isn’t flashy, but it works. I don’t care how we cure someone; I just want to cure them.

Is one strategy smarter than another? Maybe, maybe not. What matters is curing the patient while keeping them alive and minimizing side effects. The field may change through incremental improvements, not one giant, noisy breakthrough.

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