Renal Cell Carcinoma
Systemic therapy for mRCC: second line and beyond

Raul (79 years old)

Raul, a 79-year-old retired bartender, still enjoys karaoke evenings with his friends. He was diagnosed with metastatic ccRCC 18 months ago. 

Assessment summary:

  • Diagnosed with metastatic ccRCC (lung) 18 months ago
    • Lumbar tumour nephrectomy on the right side
    • Thoracotomy with resection of pulmonary metastasis
    • pT3aM1, microscopic venous invasion, no lymphatic invasion, no residual tumour
    • Grade 3 ccRCC
  • IMDC: intermediate risk
  • Medical history: hypertension, absence factor XII, prostate cancer (local disease, in remission since years)
  • 6 months later: new lung metastasis
    • First-line therapy with axitinib + pembrolizumab started
    • Partial remission of lung metastasis
  • Now, 12 months later: disease progression in the lung and new metastases (lymph nodes, gastrointestinal (duodenum and gastric))

Which treatment option would you choose for this patient?