Over the last decade, tyrosine kinase inhibitors and immune checkpoint inhibitors have revolutionized the treatment landscape for patients with metastatic renal cell carcinoma (mRCC). Currently, immunotherapy-based combination therapy (i.e. pembrolizumab-axitinib, avelumab-axitinib, nivolumab-ipilimumab) is the preferred first line treatment option for patients with mRCC. But even with these regimens the complete response rate is limited at approximately 8–9%. In this context, metastasis directed therapy (MDT) remains the only potentially curative treatment option for patients with mRCC. During the 2021 BMUC meeting, Prof. Shankar Siva (Peter McCallum Cancer Centre, Melbourne, Australia), discussed the current state of affairs with respect to MDT in the contemporary mRCC treatment landscape.