What is your regimen of choice for metastatic papillary renal cell carcinoma?

My regimen of choice for papillary RCC is cabozantinib given recent evidence. Papillary renal cancer has not had a standard established therapy until recently. Most of the clinical trials in kidney cancer restricted eligibility to clear cell carcinoma component. SWOG 1500 reported results of a randomized trial comparing multiple VEGF-TKI therapies in metastatic papillary renal cancer. The study results show that cabozantinib had improved response rate and progression free survival as compared to...

I have had a few papillary patients I have put on nivo cabo with surprisingly little fuss from insurance. Extrapolating data that each of them are individually effective in papillary. The problem I run into is what to do at progression, perhaps lenvatinib, or axitinib, or maybe even TiVo in this setting.