Case 2025: Isabel (expert opinion by L. Pickering)

Isabel, 58 years old, is a winemaker in the Douro Valley, where her family has cultivated vines for generations. She oversees not only the harvest but also the storytelling sessions at dusk, when workers and guests gather to taste port and listen to her memories of seasons past.

Lately, fatigue and a persistent ache led her to seek medical advice. She was diagnosed with metastatic papillary RCC.

Assessment summary:

• Medical history: hypertension (managed with ACE inhibitors); no known contraindications to ICI or VEGFR-TKI therapy
• CT scan: right renal mass, mediastinal lymphadenopathy and two bilateral pulmonary nodules (largest 3.5 cm); cT3aN1M1
• Renal biopsy: pRCC, WHO/ISUP grade 3
• ECOG PS: 1 (fatigue and mild weight loss)
• KPS: 80%
• Blood work normal, except:
  • Haemoglobin: 10.5 g/dL (reference: 12-15 g/dL)