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The treatment of patients with intermediate- and poor-risk metastatic renal cell carcinoma (RCC) has been dramatically changed with the introduction of immune checkpoint inhibitors (immunotherapy) as a first-line of treatment after surgery. However, it is less clear whether immunotherapy benefits patients with favourable-risk disease in the same way. A debate between experts at the International Kidney Cancer Symposium in Miami this week highlights different approaches to the treatment of favourable-risk RCC, including tyrosine kinase inhibitors (VEGF inhibitors), combination immunotherapy and active surveillance.