How do you treat metastatic collecting duct carcinoma of the kidney in the first line setting?

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 wo...

I agree with @Dr. First Last. 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.nlm.nih.gov/p...