Case 2024: Josef (expert opinion by L. Pickering)

Josef, 67 years old, has been a gardener at the Belvedere Palace for 40 years. Since he retired, 2 years ago, he often visits his beloved garden to appreciate the stunning view and talk with the visitors.

Fifteen months ago, he was diagnosed with metastatic clear-cell RCC (ccRCC) and underwent nephrectomy and stereotactic body radiation therapy (SBRT) of 1 rib metastasis (pT3aN0M1, WHO/ISUP grade 3, no sarcomatoid features).

Regular scans every 3 months showed no new metastatic lesions.

Current situation:

• ECOG PS: 1
• Karnofsky performance status (KPS): 80%
• Asymptomatic
• No contra-indications to immune checkpoint inhibitors (ICI) or vascular endothelial growth factor receptor tyrosine kinase inhibitor (VEGFR-TKI) therapy
• Imaging: multiple new spine and rib metastases
• Blood work: normal