Mitigating the Risk of Skeletal Events in Metastatic Renal Cell Carcinoma

Bone metastases affect approximately one-third of patients with metastatic renal cell carcinoma (mRCC) and contribute to substantial skeletal complications and shorter survival. Management of these metastases requires a multidisciplinary approach combining systemic therapies, localized treatments, and supportive care. Immune checkpoint inhibitor (ICI)-based combinations, especially doublets comprising an ICI and a VEGF-targeted tyrosine kinase inhibitor, have shown significant efficacy in mRCC with bone involvement. Bone-modifying agents such as zoledronic acid and denosumab help in mitigating symptomatic skeletal-related events and enhance bone integrity, although the unique bone pathology of RCC may limit their effectiveness. Local therapies, such as surgery and stereotactic body radiotherapy, play a pivotal role in providing symptom relief and controlling localized disease, particularly in oligometastatic cases. A personalized, patient-centered strategy is essential in minimizing systemic therapy disruptions, addressing skeletal morbidity, and improving clinical outcomes. PATIENT SUMMARY: Bone metastases in patients with kidney cancer can cause severe complications such as pain, fractures, and other serious issues, reducing quality of life and survival. Treatment involves a combination of therapies, including medications, targeted radiation, surgery, and immunotherapy, tailored to each patient to manage symptoms and improve outcomes.