Advanced Urologic Cancer Consensus Conference (AUC3) 2025: Expert consensus on the management of renal cell and urinary tract cancers
The therapeutic landscape for renal cell carcinoma (RCC) and urinary tract cancer (UTC) has transformed dramatically, creating complexity in treatment selection and sequencing. The 2025 Advanced Urologic Cancer Consensus Conference was convened to establish evidence-based expert consensus recommendations for optimal management. A multidisciplinary panel of 51 experts participated in a modified Delphi process addressing questions developed through iterative consensus-building covering RCC and UTC management. Voting occurred before and after the conference, and analyses focused on postmeeting responses. Consensus was defined as ≥75% agreement, with strong consensus as >90%. Strong consensus was found on the use of adjuvant pembrolizumab for higher risk RCC (pathologic T2 [pT2], grade 4; pT3-pT4, any grade; pTXN1; or fully resected metastatic disease) and on neoadjuvant therapy before cystectomy for localized UTC. There was strong consensus on the use of enfortumab vedotin plus pembrolizumab as frontline therapy for metastatic UTC and the use of platinum-based chemotherapy postprogression in biomarker-negative UTC. For RCC, there was consensus on the role of single-agent vascular endothelial growth factor receptor-tyrosine kinase inhibitor therapy after progression on frontline immune checkpoint inhibitor/vascular endothelial growth factor receptor-tyrosine kinase inhibitor therapy or dual immune checkpoint inhibitor therapy. However, there was a lack of consensus on other critical areas in the management of RCC and UTC. The 2025 Advanced Urologic Cancer Consensus Conference provides evidence-informed guidance for complex clinical scenarios while identifying critical research priorities. The group recognizes that the lack of consensus across multiple areas highlights the need for improved patient selection and prospective studies enabling optimal combination and sequencing approaches. This iterative annual process will address evolving treatment paradigms to optimize outcomes.
Authors
- Rick Bangs (ORCID: https://orcid.org/0000-0002-0706-8775)
- Abhishek Tripathi (ORCID: https://orcid.org/0000-0003-4466-1874)
- David F. McDermott (ORCID: https://orcid.org/0000-0002-2675-5095)
- Eric Jonasch (ORCID: https://orcid.org/0000-0003-0943-2806)
- Oleksandr N. Kryvenko (ORCID: https://orcid.org/0000-0001-5731-1748)
- Chad Z. Tang (ORCID: https://orcid.org/0000-0002-5915-1327)
- Matthew D. Galsky (ORCID: https://orcid.org/0000-0001-7655-9378)
- Joshua Meeks (ORCID: https://orcid.org/0000-0001-8535-5545)
- Brian Shuch (ORCID: https://orcid.org/0000-0003-2065-3570)
- Bryan Lewis (ORCID: https://orcid.org/0000-0002-9744-9247)
- Benjamin Louis Maughan (ORCID: https://orcid.org/0000-0002-0010-8551)
- Brian I. Rini (ORCID: https://orcid.org/0000-0002-2212-080X)
- Petros D. Grivas (ORCID: https://orcid.org/0000-0003-3965-3394)
- Michelle S. Hirsch (ORCID: https://orcid.org/0000-0002-8767-8564)
- Michiel S. van der Heijden (ORCID: https://orcid.org/0000-0002-4407-7881)
- Vadim S. Koshkin (ORCID: https://orcid.org/0000-0003-2277-8668)
- Daniel Yick Chin Heng
- Andrea B. Apolo (ORCID: https://orcid.org/0000-0001-9409-1836)
- Srikala S. Sridhar (ORCID: https://orcid.org/0000-0002-6994-1285)
- Naomi B. Haas (ORCID: https://orcid.org/0000-0001-8907-7968)
- Sima P. Porten (ORCID: https://orcid.org/0000-0002-3948-4968)
- Jason A. Efstathiou (ORCID: https://orcid.org/0000-0003-0996-0350)
- Mehmet Asım Bilen (ORCID: https://orcid.org/0000-0003-4003-1103)
- Daniel Peter Petrylak (ORCID: https://orcid.org/0000-0001-6165-5797)
- Jonathan E. Rosenberg (ORCID: https://orcid.org/0000-0003-2637-4249)
- Guru Sonpavde (ORCID: https://orcid.org/0000-0002-1010-9611)
- Toni K. Choueiri (ORCID: https://orcid.org/0000-0002-9201-3217)
- Michael B. Atkins (ORCID: https://orcid.org/0000-0003-3901-9924)
- Roger Li (ORCID: https://orcid.org/0000-0003-1274-7200)
- Arlene O. Siefker‐Radtke (ORCID: https://orcid.org/0000-0002-6328-9599)
- Rana R. McKay (ORCID: https://orcid.org/0000-0002-0581-7963)
- Robert John Motzer (ORCID: https://orcid.org/0000-0001-6925-2327)
- Bradley A. McGregor (ORCID: https://orcid.org/0000-0002-8298-0289)
- Wenxin Xu (ORCID: https://orcid.org/0000-0002-8450-2037)
- Gopa Iyer (ORCID: https://orcid.org/0000-0002-5093-6099)
- Wanling Xie (ORCID: https://orcid.org/0000-0001-5995-8000)
- David H. Aggen (ORCID: https://orcid.org/0000-0003-3963-5751)
- David A. Braun (ORCID: https://orcid.org/0000-0003-4543-5553)
- Sumanta Pal
- Stephanie Berg (ORCID: https://orcid.org/0000-0001-6193-5350)
- Maria Isabel Carlo (ORCID: https://orcid.org/0000-0002-4786-7408)
- Kathryn E. Beckermann (ORCID: https://orcid.org/0000-0002-4616-6140)
- Laurence Albigès (ORCID: https://orcid.org/0000-0002-5734-3480)
- Joaquim Bellmunt (ORCID: https://orcid.org/0000-0003-2328-3421)
- Cristina Suárez (ORCID: https://orcid.org/0000-0002-0502-5528)
- Andrea Necchi (ORCID: https://orcid.org/0000-0002-3007-2756)
- Matthew I. Milowsky (ORCID: https://orcid.org/0000-0002-8965-8129)
- Surena F. Matin (ORCID: https://orcid.org/0000-0003-1638-1445)
- Shilpa Gupta
- A. Ari Hakimi (ORCID: https://orcid.org/0000-0002-0930-8824)
- Thomas B. Powles (ORCID: https://orcid.org/0000-0001-7760-4724)
- Martin Henner Voss (ORCID: https://orcid.org/0000-0003-0551-5807)
- Tian Zhang (ORCID: https://orcid.org/0000-0001-8914-3531)
- Hans J. Hammers (ORCID: https://orcid.org/0000-0002-6224-4559)
Institutions
- Northwestern University (US)
- University of North Carolina at Chapel Hill (US)
- Brigham and Women's Hospital (US)
- National Institutes of Health (US)
- Beth Israel Deaconess Medical Center (US)
- Cleveland Clinic (US)
- Memorial Sloan Kettering Cancer Center (US)
- The University of Texas MD Anderson Cancer Center (US)
- University of Miami (US)
- Emory University (US)
- University of California, Los Angeles (US)
- Queen Mary University of London (GB)
- University of Calgary (CA)
- University of California, San Francisco (US)
- Georgetown University (US)
- University of Toronto (CA)
- University of Milan (IT)
- Vanderbilt University (US)
- Georgetown University Medical Center (US)
- Huntsman Cancer Institute (US)
- Institut Gustave Roussy (FR)
- University of Washington Medical Center (US)
- Foothills Medical Centre (CA)
- Princess Margaret Cancer Centre (CA)
- Yale Cancer Center (US)
- The Netherlands Cancer Institute (NL)
- Moffitt Cancer Center (US)
- University of California San Diego (US)
- Florida Hospital Cancer Institute (US)
- Massachusetts General Hospital (US)
- Fred Hutch Cancer Center (US)
- City of Hope (US)
- Oncode Institute (NL)
- Dana-Farber Cancer Institute (US)
- Tisch Hospital (US)
- Vall d'Hebron Hospital Universitari (ES)
- Tennessee Oncology (US)
- Kidney Associates (US)
- National Cancer Institute (US)
- Bladder Cancer Advocacy Network (US)
- Center for Cancer Research (US)
- Fondazione IRCCS Istituto Nazionale dei Tumori (IT)
- Vall d'Hebron Institute of Oncology (ES)
- University of Pennsylvania (US)
- The University of Texas Southwestern Medical Center (US)
- Icahn School of Medicine at Mount Sinai (US)
Publication Details
- Journal
- CA A Cancer Journal for Clinicians
- Published
- 2025-12-13
- DOI
- https://doi.org/10.3322/caac.70052
- Primary Topic
- Renal cell carcinoma treatment
- Type
- article
- Field-Weighted Citation Impact
- 0.00