Sarcomatoid RCC ICI — SCE Medical Oncology MCQ
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Correct answer: B — Aggressive morphology with disproportionate sensitivity to checkpoint combinations
Sarcomatoid differentiation is an adverse morphological feature of RCC but predicts comparatively strong response to checkpoint-based combinations. Aggressive morphology with preferential sensitivity to VEGFR-TKI monotherapy: sarcomatoid RCC has shown disproportionate benefit from checkpoint combinations. Aggressive morphology with preferential sensitivity to cytotoxic sarcoma chemotherapy: sarcomatoid change remains RCC and is not managed as a separate soft-tissue sarcoma. Aggressive morphology with preferential sensitivity to mTOR-inhibitor monotherapy: mTOR monotherapy is not the defining treatment implication. Aggressive morphology with preferential sensitivity to radiotherapy monotherapy: systemic metastatic disease requires systemic therapy and RCC radiotherapy is site directed.
Reference: NICE TA780 nivolumab with ipilimumab for advanced RCC (Published March 2022; current NICE TA): https://www.nice.org.uk/guidance/ta780/chapter/1-Recommendations; NICE NG256 kidney cancer: managing advanced renal-cell carcinoma (Published March 2026): https://www.nice.org.uk/guidance/NG256/chapter/managing-advanced-renal-cell-carcinoma