Outcomes of cancer research are usually described in relation to cancer recurrence, progression, and/or patient survival. These outcomes are essential; however, they may not capture the full impact of cancer on patient's functioning and social well being, especially in elderly patients [1]. Elderly cancer patients are usually under-represented in clinical trials [2]. There are growing reports that in a significant proportion of the elderly cancer population, maintaining an adequate quality of life is more important than length of life [3].

Although renal cell carcinoma (RCC) represents only approximately 4% of adult malignancies in Europe, it displays the highest mortality rate of all urologic tumors with 40% of RCC patients dying from the disease [1]. In Germany, about 15,100 people are expected to be diagnosed with RCC in 2018 and an estimated 5,400 patients will die of kidney cancer each year [2]. As RCC does not immediately lead to clinical symptoms, about 20% to 30% of RCC patients present with advanced or metastatic disease (mRCC) at diagnosis [3] and about 20% of patients diagnosed with localized disease will subsequently develop metastases [4,5].

Several molecular targeted agents have been approved since 2008 for the treatment of advanced renal cell carcinoma (RCC) in Japan and include vascular endothelial growth factor (VEGF) pathway inhibitors and mammalian target of rapamycin inhibitors. These therapeutic agents have prolonged the survival of patients with RCC. However, most patients treated with molecular targeted agents will ultimately acquire resistance to these agents, resulting in disease progression. Many potential prognostic and predictive molecular biomarkers have now been identified in RCC, although none has yet entered clinical practice [1].