How would you treat a patient with metastatic renal cell and ESRD on dialysis?

It is now well recognized that patients with CKD, including ESKD on dialysis, are at increased risk of cancer of the native kidney(s). Patients with localized disease are candidates for local therapy or surgery. For metastatic disease, selection of an agent, dose adjustment, and timing in relation to dialysis are important considerations. It is also important to consider the co-morbid conditions. Cardiovascular diseases are more prevalent in dialysis patients and they are also at higher risk of bleeding, thrombosis, and infection.

Although limited or no pharmacokinetic data are available in this population, none of the check-point inhibitors and TKIs, commonly used for metastatic RCC, are known to be cleared through dialysis. Manufacturers...