Voog E, et al. - Researchers report the outcomes under real-life circumstances of a sequential treatment strategy for metastatic renal cell carcinoma, prior to the era of immunotherapy. For advanced renal cell carcinoma, all patients received treatments based on their prognostic score (either MSKCC or IMDC). Including a rechallenge criterion for the repeat use of a treatment class, a treatment strategy including 1 to 4 lines was ascertained. In this study including 344 patients, patients with good or intermediate prognosis experienced an overall survival of 57 months and patients with poor prognosis had an overall survival of 19 months. For lines 1 to 4, 46%, 36%, 16% and 17% were the respective estimated best objective response rates. A performance status good enough to receive a systemic therapy was found in a substantial proportion of patients with good or intermediate prognosis who progressed following two lines of treatment, this finding justifies such a strategy. The applied approach was suggested to be beneficial as long overall survival was observed in patients with good and intermediate prognosis. In the era of immune checkpoint inhibitors, these findings might be used as a selection criterion for the treatment of patients.