One of the largest studies by Pal et al., which included 220 mRCC patients, promisingly reported RCC-specific alterations in genes such as VHL, TP53, EGFR, NF1, and ARID1A in almost 80% of the patients when using a driver gene deep sequencing approach, with great sensitivity to mutant cfDNA fragments (<1%) (27). This evidence concerns the gene VHL and renal cell carcinoma.