While VEGF TKI monotherapy is fast shrinking and narrowing as a treatment option for first-line therapy in metastatic RCC, the Checkmate 214 trial shows that patients with favorable risk disease per the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) criteria tend to still do better with sunitinib monotherapy compared to IO combination therapy. This evidence concerns the gene VEGFA and renal cell carcinoma.