What is your approach to metastatic non-clear cell RCC?

A majority of the clinical trials conducted in renal cell carcinoma are conducted exclusively in clear cell carcinoma. We know from retrospective analyses (De Velasco et al Clin GU Cancer 2017) that these patients have a worse prognosis with traditional therapy. Small randomized trials dedicated exclusively to non clear cell carcinoma (ASPEN and ESPN) show improved response rates with suntinib versus everolimus (Armstrong Lancet Oncol, Tannir EurUrol)

Several trials are ongoing or near accrual in non-clear cell carcinoma. A phase 2 trial is exploring the role of atezolizumab and bevacizumab in those with non-clear cell carcinoma including clear cell with > 20% sarcomatoid features with accrual nearly complete and results expected soon. The P...