How would you treat a patient with metastatic clear cell renal cancer who has progressed on immunotherapy and developed bleeding on cabozantinib?

This is not an uncommon situation. Any VEGFR inhibitor can indeed raise the risk of bleeding. An answer depends on the details of the bleeding-like one episode vs ongoing chronic bleeding, severity, arterial vs venous, location, GI vs CNS vs elsewhere, other contributing factors like anti-coagulants in use, aspirin, plavix, etc. If the source of the bleeding can be controlled, would be the way to go. If any of the other contributing factors can be mitigated, would do that. If after all these are looked into, the physician feels cabozantinib poses a major risk of bleeding in the future, can switch to axitinib or lenvatinib. It comes down to risk management in the end.