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

Ares (60 years old)

Ares recently turned 60 years old. Although his diagnosis spoiled the mood for a birthday celebration, his family convinced him to go on a trip to Iceland. The beautiful nature managed to somewhat take his mind off the situation.

Six months ago, he was diagnosed with metastatic ccRCC and underwent nephrectomy and local treatment of one metastatic site in the lung (pT3aN0M1, WHO/ISUP grade 3, no sarcomatoid features).

Current situation:

  • ECOG PS: 1
  • KPS: 80%
  • Asymptomatic
  • No contra-indications to ICI or VEGFR-TKI therapy
  • CT scan: multiple new, bilateral lung metastases between 0.8-2.4 cm, progressive disease
  • Blood work:
    • Haemoglobin: 10.1 g/dl (12-13 g/dl)
    • Otherwise normal

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