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

Annika (64 years old)

Annika is a 64-year-old office manager in the law firm. In her free time, she is very creative and makes her own greeting cards. She was diagnosed with primary bone metastatic ccRCC on the left side 9 months ago.

Assessment summary:

  • Histology confirmed with biopsy
  • At least cT3aN0M1 with infiltration of left renal vein
  • IMDC: poor risk
  • Medical history: pulmonary embolism, tricuspid insufficiency grade I, left ventricular ejection fraction (LVEF) is normal

She started first-line therapy with nivolumab + ipilimumab.

  • After 6 months: 1 new lung and 1 bone lesion
  • Asymptomatic

Which treatment option would you choose for this patient?