What is your preferred first line therapy for metastatic sarcomatoid renal cell carcinoma?

Sarcomatoid RCC is a heterogeneous and difficult disease. Arising across all histologies, it generally portends a worse prognosis. VEGF TKIs have activity and I think are the default standard of care, but outcomes are suboptimal. Chemotherapy regimens have been tried with limited success, although I dont think their toxicity justifies any small benefit. The good news is that the checkpoint inhibitors appear to have activity here, although data is sparse at present. The recently reported IMMotion...

Until recently I treated these patients with sarcomatoid variant mRCC with sunitinib. With availablility of ipi/nivo and impending approval of bev/atezo, I would switch to these regimens.