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...

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.