In metastatic/recurrent clear cell carcinoma with a solitary site of metastasis to the bone when, if ever, do you consider local therapy adequate and hold systemic therapy?   

If I have a patient with a treated solitary metastatic site in RCC (bone or otherwise), I generally give local therapy and historically would not give systemic therapy. A point of discussion would be use of adjuvant pembro in this setting. While bone mets were not included in KEYNOTE-564 resected M1...