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McKay notes that on the horizon there are additional triplet therapy combination trials for patients in the first line setting, notably MK6482-012, which is testing belzutifan + pembrolizumab + lenvatinib versus quavonlimab + lenvatinib versus pembrolizumab + lenvatinib: Another study upcoming is the PDIGREE (Alliance A031704) trial that is testing maintenance IO-VEGF, specifically nivolumab + ipilimumab followed by nivolumab or nivolumab + cabozantinib: With regards to treatment options for non-clear cell RCC, there are several studies showing benefit, namely the PapMet trial assessing cabozantinib for papillary RCC (objective response rate 23%) and the Savior trial assessing savolitinib for met-driven RCC (objective response rate 27%): In the era of doublet and now potentially triplet therapy, it is important to balance the goals of selection of therapy: Benefits: improve overall survival, improved progression free survival, improved response rate, limited progressive disease rate, durability of response, depth of response, complete response, treatment-free survival, and improved quality of life Risks: immune-mediate adverse events, chronic TKI toxicity, limited durability of response, primary progressive disease rate, and no benefit in quality of life In 2024, Dr