Renal Cell Carcinoma
First-line systemic therapy in metastatic renal cell carcinoma

Jasper (60 years old)

60-year-old Jasper is a pathologist. In his free time, he likes to attend theatrical performances and opera.

Five years ago, he was diagnosed with metastatic clear-cell RCC (ccRCC) and underwent nephrectomy and local treatment of 1 metastatic site in the lung (pT3aN0M1, WHO/ISUP grade 3, no sarcomatoid features).

Current situation:

  • ECOG PS: 1
  • Karnofsky performance status (KPS): 80%
  • Asymptomatic
  • No contra-indications to immune checkpoint inhibitors (ICI) or vascular endothelial growth factor receptor tyrosine kinase inhibitor (VEGFR-TKI) therapy
  • CT scan: multiple new lung metastases between 0.8-1.4 cm, progressive disease
  • Blood work: normal

Which of the following treatment options would you choose for this patient?