Case 1: Jasper (60 years old)

60-year-old Jasper is a pathologist. In his free time, he likes to attend theatrical performances and opera.

Five years ago, he was diagnosed with metastatic clear-cell RCC (ccRCC) and underwent nephrectomy and local treatment of 1 metastatic site in the lung (pT3aN0M1, WHO/ISUP grade 3, no sarcomatoid features).

Current situation:

• ECOG PS: 1
• Karnofsky performance status (KPS): 80%
• Asymptomatic
• No contra-indications to immune checkpoint inhibitors (ICI) or vascular endothelial growth factor receptor tyrosine kinase inhibitor (VEGFR-TKI) therapy
• CT scan: multiple new lung metastases between 0.8-1.4 cm, progressive disease
• Blood work: normal