What second line therapy would you use for metastatic clear cell RCC after a 6-12 month response to ipilimumab/nivolumab followed by development of multiple bone metastases but stable soft tissue disease?

Great question. Options include agents such as cabozantinib, lenvatinib/everolimus, and axiitnib. I favor cabozantinib in this setting because of its track record of activity in bony metastases in the METEOR trial and other studies. Also, please keep in mind the availability of CONTACT-3, which is a...

I will diverge from @Dr. First Last's answer a bit. I'm not as convinced about cabo's enhanced activity in bone mets. I think much of that is derived from METEOR when cabo was compared to an mTOR agent, not another VEGFR inhibitor. Nonetheless, single agent TKI is SOC here (perhaps with SBRT to bone...