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To my experience, Papillary RCC is always a frustrating experience with almost any of those managements from TKIs to IOs. There is no therapy available. So my opinion is local measures almost always. The trick is to find the best timing, always trying to learn the velocity of progression as much as we can, with clinical monitoring and Scans q 3-4 months. The magnitude of distant disease otherwise and location of symptoms or predictability of symptoms is always an important feature to consider.
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