What would you recommend as first line therapy for metastatic chromophobe RCC?

Albeit limited data, I favor an IO-TKI doublet for chromophobe RCC. The recent B61 trial with Len/Pembro showed a response rate in the 25% range for this historically IO non-responsive subtype. I think all patients should get an IO-based regimen up front as no other regimens have curative potential. Len/ev and other TKI-based approaches are reasonable as salvage and can achieve some disease control but are not curative. We need a deeper understanding of chromophobe biology for more effective therapeutics.