Emma (67 years old)

Emma is a 67-year-old woman who regularly takes care of stray cats that are brought to the local shelter. She was diagnosed with mRCC about 2 years ago after admission to the emergency department with macroscopic haematuria. She has a history of active smoking (50 pack-years) and dyslipidaemia.

About 2 years ago:

• CT scan: right renal mass and 2 small lung nodules in right upper lobe (3 and 5 mm)
• Underwent cytoreductive nephrectomy (CN): clear-cell RCC (ccRCC), no sarcomatoid/rhabdoid features – pT2N0M1, WHO/ISUP grade 3

Lost to follow-up, now:

• CT scan: largest lesion stable at 5 mm, but smallest lesion grown from 3 to 12 mm
• CT-guided lung biopsy of growing lesion: confirmed metastatic ccRCC
• No symptoms
• No contra-indications to immunotherapy or VEGFR-TKI therapy
• ECOG PS: 0
• KPS: 90%
• Blood work: normal