Susanne Osanto, MD, PhD, from the Leiden University Medical Center, Leiden, Netherlands, discusses the current landscape and future direction of systemic therapy for renal cell carcinoma (RCC) at the European Association of Urology (EAU) conference 2017 in London, UK. She highlights that impressive developments have been seen in metastatic kidney cancer. She describes results from a randomized Phase II study using a combination of lenvatinib and everolimus (NCT01136733), as well as the CheckMate 025 Phase III randomized trial (NCT01668784) and Phase III METEOR trial (NCT01865747) comparing everolimus with cabozantini. According to Prof. Osanto, recent trials have revolutionized the treatment of patients with metastatic kidney cancer as there are many more drugs to choose from. However, this is also a challenge as clinicians do not currently have the tools to enable them to select the best second-line treatment for each patient.