Advanced Urologic Cancer Consensus Conference (AUC3) 2025: Expert consensus on the management of renal cell and urinary tract cancers
Abstract
Abstract 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.
Article Details
Authors (54)
Rana R. McKay
Department of Medicine, Urology, and Radiation Medicine and Applied Sciences University of California‐San Diego La Jolla California USA
Sumanta Pal
Department of Medical Oncology and Therapeutics Research City of Hope Comprehensive Cancer Center Duarte California USA
Wanling Xie
Department of Medical Oncology Dana‐Farber Cancer Institute Boston Massachusetts USA
David Aggen
Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
Laurence Albiges
Department of Medical Oncology Gustave Roussy Villejuif France
Andrea Apolo
Genitourinary Malignancies Branch, Center for Cancer Research National Cancer Institute National Institutes of Health Bethesda Maryland USA
Michael B. Atkins
Department of Oncology Georgetown Lombardi Comprehensive Cancer Center Georgetown University Washington District of Columbia USA
Rick Bangs
Bladder Cancer Advocacy Network Bethesda Maryland USA
Kathryn E. Beckermann
Department of Medicine Tennessee Oncology Nashville Tennessee USA
Joaquim Bellmunt
Department of Medical Oncology Dana‐Farber Cancer Institute Boston Massachusetts USA
Stephanie A. Berg
Department of Medical Oncology Dana‐Farber Cancer Institute Boston Massachusetts USA
Mehmet A. Bilen
Department of Hematology and Medical Oncology Winship Cancer Institute Emory University Atlanta Georgia USA
David Braun
Section of Medical Oncology, Department of Medicine Yale Cancer Center Yale University New Haven Connecticut USA
Maria I. Carlo
Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
Jason Efstathiou
Department of Radiation Oncology Massachusetts General Hospital Boston Massachusetts USA
Matthew Galsky
Division of Hematology and Medical Oncology, Department of Medicine Tisch Cancer Institute Icahn School of Medicine at Mount Sinai New York New York USA
Petros Grivas
Division of Medical Oncology, Department of Medicine University of Washington Seattle Washington USA
Shilpa Gupta
Department of Hematology and Medical Oncology Taussig Cancer Institute Cleveland Clinic Cleveland Ohio USA
Naomi Haas
Division of Hematology‐Oncology, Department of Medicine Abramson Cancer Center University of Pennsylvania Philadelphia Pennsylvania USA
A. Ari Hakimi
Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
Hans Hammers
Division of Hematology‐Oncology, Department of Internal Medicine University of Texas Southwestern Medical Center Dallas Texas USA
Daniel Y. C. Heng
Department of Medical Oncology Tom Baker Cancer Center University of Calgary Calgary Alberta Canada
Michelle Hirsch
Department of Pathology Brigham and Women's Hospital Boston Massachusetts USA
Gopakumar Iyer
Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
Eric Jonasch
Department of Genitourinary Medical Oncology The University of Texas MD Anderson Cancer Center Houston Texas USA
Vadim S. Koshkin
Division of Hematology/Oncology, Department of Medicine University of California‐San Francisco San Francisco California USA
Oleksandr N. Kryvenko
Department of Pathology and Laboratory Medicine University of Miami Miller School of Medicine Miami Florida USA
Bryan Lewis
KidneyCan Philadelphia Pennsylvania USA
Roger Li
Department of Genitourinary Oncology Moffitt Cancer Center Tampa Florida USA
Surena Matin
Department of Genitourinary Medical Oncology The University of Texas MD Anderson Cancer Center Houston Texas USA
Benjamin Maughan
Division of Medical Oncology, Department of Medicine Huntsman Cancer Institute University of Utah Salt Lake City Utah USA
David F. McDermott
Division of Medical Oncology, Department of Medicine Beth Israel Deaconess Medical Center Boston Massachusetts USA
Bradley McGregor
Department of Medical Oncology Dana‐Farber Cancer Institute Boston Massachusetts USA
Joshua Meeks
Department of Urology Northwestern University Feinberg School of Medicine Chicago Illinois USA
Matthew Milowsky
Division of Medical Oncology, Department of Medicine Lineberger Comprehensive Cancer Center University of North Carolina Chapel Hill North Carolina USA
Robert Motzer
Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
Andrea Necchi
Department of Medical Oncology Fondazione IRCCS Istituto Nazionale dei Tumori University of Milan Milan Italy
Dan Petrylak
Section of Medical Oncology, Department of Medicine Yale Cancer Center Yale University New Haven Connecticut USA
Sima Porten
Division of Hematology/Oncology, Department of Medicine University of California‐San Francisco San Francisco California USA
Thomas Powles
Department of Medical Oncology Barts Cancer Institute Queen Mary University of London London UK
Brian Rini
Division of Hematology/Oncology, Department of Medicine Vanderbilt‐Ingram Cancer Center Vanderbilt University Nashville Tennessee USA
Brian Shuch
Department of Urology University of California‐Los Angeles Los Angeles California USA
Arlene Siefker‐Radtke
Department of Genitourinary Medical Oncology The University of Texas MD Anderson Cancer Center Houston Texas USA
Guru Sonpavde
Department of Genitourinary Oncology AdventHealth Cancer Institute Orlando Florida USA
S. Srikala Sridhar
Division of Medical Oncology Princess Margaret Cancer Center University of Toronto Toronto Ontario Canada
Cristina Suarez
Department of Medical Oncology Vall d'Hebron Institute of Oncology Hospital Universitari Vall d'Hebron Barcelona Spain
Chad Tang
Department of Genitourinary Medical Oncology The University of Texas MD Anderson Cancer Center Houston Texas USA
Abhishek Tripathi
Department of Medical Oncology and Therapeutics Research City of Hope Comprehensive Cancer Center Duarte California USA
Michiel S. Van Der Heijden
Department of Medical Oncology Netherlands Cancer Institute Amsterdam Netherlands
Martin Voss
Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
Wenxin Xu
Department of Medical Oncology Dana‐Farber Cancer Institute Boston Massachusetts USA
Tian Zhang
Division of Hematology‐Oncology, Department of Internal Medicine University of Texas Southwestern Medical Center Dallas Texas USA
Jonathan Rosenberg
Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
Toni K. Choueiri
Department of Medical Oncology Dana‐Farber Cancer Institute Boston Massachusetts USA