Table 1.

Patient	Disease extent at diagnosis	Neoadjuvant CPI therapy	Radiographic response after neoadjuvant CPI	Pathology results at time of cytoreductive nephrectomy (CN)	Current status
#1 (IMDC poor risk)	Right renal primary, retroperitoneal lymph nodes, lung nodules, low-volume osseous metastases	4 cycles ipilimumab 1 mg/kg IV and nivolumab 3 mg kg IV every 3 weeks 4 cycles nivolumab monotherapy 480 mg IV every 4 weeks prior to CN Completed 11 further cycles of nivolumab monotherapy 480 mg IV every 4 weeks post-operatively	Near-CR of pulmonary metastases, near-CR of retroperitoneal lymphadenopathy, PR of primary renal lesion	Right nephrectomy: Extensive necrosis and histiocytic response, consistent with treatment effect; no viable tumor identified Marked interstitial nephritis, segmental and global glomerulosclerosis in peritumoral non-neoplastic kidney parenchyma, not involving distant renal parenchyma One lymph node with no evidence of malignancy (0/1)	Active surveillance, NED
#2 (IMDC poor risk)	Right renal primary (large, heterogeneously enhancing), lung nodules, large lytic metastasis in the right scapula	4 cycles ipilimumab 1 mg/kg IV and nivolumab 3 mg kg IV every 3 weeks 2 cycles nivolumab monotherapy 480 mg IV every 4 weeks prior to CN Completed 10 further cycles of nivolumab monotherapy 480 mg IV every 4 weeks post-operatively	Stable/persistent infiltrative, multinodular mass within the right kidney, mixed response in the lungs and stability of osseous metastases.	Right nephrectomy: Clear cell renal cell carcinoma (5.2 cm), WHO/ISUP grade 4, with extensive treatment effect, invading renal sinus fat, resection margins uninvolved Renal vein with intraluminal thrombus without viable tumor Simple cortical cyst Interstitial chronic inflammation, mild to moderate arterionephrosclerosis and multiple vessels with organized thrombi Adrenal gland, right, adrenalectomy No histopathologic abnormality	Interval development of solitary CNS metastasis s/p radiosurgery Initiated second line cabozantinib
#3 (IMDC intermediate risk)	12.3 cm right renal mass with tumor thrombus invading the IVC and liver invasion, mediastinal lymphadenopathy, and pulmonary nodules	4 cycles ipilimumab 1 mg/kg IV and nivolumab 3 mg kg IV every 3 weeks 7 cycles nivolumab monotherapy 480 mg IV every 4 weeks prior to CN Completed 7 further cycles of nivolumab monotherapy 480 mg IV every 4 weeks post-operatively	Slight increase in the size of the right renal mass, marked increase in the adenopathy around the renal mass and in the kidney, and slight decrease in the size of pulmonary nodules	Tumor thrombus excision with clear cell renal cell carcinoma, involving vessel wall Renal cell carcinoma (12 cm), clear cell type, WHO/ISUP grade 4 with rhabdoid features and extensive necrosis, invading adrenal gland by direct extension, extensively involving perinephric and hilar soft tissue Carcinoma abuts but does not invade liver and diaphragm Renal cortical scars, patchy interstitial chronic inflammation and focal global glomerulosclerosis (25%)	Interval development metastases involving the lumbar spine and psoas muscle Initiated second line axitinib and pembrolizumab
#4 (IMDC intermediate risk)	7.3 × 9.1 × 8.7 cm mass in the left kidney as well as multifocal osseous metastatic disease involving the sternum, cervical spine, thoracic spine, left acetabulum, and left tibia.	3 cycles ipilimumab 1 mg/kg IV and nivolumab 3 mg kg IV every 3 weeks	Persistent osseous metastatic disease with progressive epidural tumor involvement of the thoracic spine. Thoracic laminectomy and excision of epidural tumor, as well thoracic spine corpectomy and T5–T7 and T9–T11 spinal fusion followed by adjuvant radiation therapy Initiated second line therapy with axitinib and pembrolizumab	Left nephrectomy: Clear cell renal cell carcinoma (6.0 cm), WHO/ISUP grade 2, confined to the kidney, resection margins uninvolved	Resumed axitinib and pembrolizumab; ongoing clinical response
#5 (IMDC intermediate risk)	Left hilar mass, multiple pleural and parenchymal metastatic lesions, and 12.6 × 12.3 cm centrally necrotic left renal mass with associated tumor thrombus.	4 cycles ipilimumab 1 mg/kg IV and nivolumab 3 mg kg IV every 3 weeks 1 cycle nivolumab monotherapy 480 mg IV every 4 weeks prior to CN	Near complete resolution of pulmonary and left hilar metastatic disease, PR of the primary left renal mass with decrease in size to 9.9 cm.	Kidney, left, radical nephrectomy: Clear cell renal cell carcinoma with extensive treatment effect, WHO/ISUP grade 4 with rhabdoid features, resection margins uninvolved Marked interstitial chronic inflammation with interstitial fibrosis/tubular atrophy No evidence of malignancy in one lymph node (0/1) Adrenal gland, left, radical nephrectomy. No evidence of viable carcinoma	Plan to continue nivolumab monotherapy