As is the case with all extremely rare neoplams we operate in a nearly completely data free zone.  This is a highly aggressive, lethal neoplasm. Cisplatin-based chemotherapy has some, albeit limited activity, thus gemcitabine/cisplatin is reasonable initial therapy if renal function is adequate...

I agree with @Robert Dreicer.  Collecting duct is a histology that we equate phenotypically to urothelial.  Therefore, my algorithm has been cisplatin/gemcitabine (+/- bev), followed by immunotherapy in the setting of failure. The reference for bevacizumab is as follows: https://www.ncbi.n...