Clinical management of oligoprogressive renal cell carcinoma

INTRODUCTION: Nearly 81,000 new cases of renal cell carcinoma are expected to be diagnosed in 2025, with more than one-third of patients presenting with or eventually developing metastatic disease. Some patients develop oligoprogressive disease, defined by limited metastatic progression. AREAS COVERED: We discuss current data evaluating the treatment approaches to patients with oligoprogressive disease. This includes active surveillance, systemic therapy, and metastasis-directed therapy such as surgical resection, stereotactic ablative radiotherapy, and percutaneous thermal ablation. We also describe the disease characteristics that we consider when deciding on the appropriate therapy for patients with oligoprogressive disease. We searched databases such as PubMed and ClinicalTrials.gov from 2000 to 2026 for trials related to these treatment options. EXPERT OPINION: Patients with oligoprogressive RCC with favorable or intermediate-risk disease and limited metastases may benefit from metastasis-directed therapy. Patients that progress on immunotherapy and require subsequent therapy should consider a tyrosine kinase inhibitor. Biomarkers are being explored to better risk-stratify patients for metastasis directed therapy.