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

Elena (64 years old)

Elena is a 64-year-old Slavic history and culture lover. In her free time, she studies Slavic languages too. 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, LVEF is normal

She started first-line therapy with nivolumab + ipilimumab.

  • After 2 months: 1 bone lesion increased in size
  • Asymptomatic

Which treatment option would you choose for this patient?