What other evaluation should be considered?

Routine labs with CBC and CMP including LFT’s, SCr level, and calcium and LDH, which have prognostic value for advanced RCC.

A plasma free metanephrines should be considered to exclude pheochromocytoma, although this diagnosis is unlikely in this circumstance.

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A percutaneous biopsy of the mass should also be considered to guide further therapy.

Summary of findings: SCr=1.33, calcium and LDH normal, and all other labs were normal. Percutaneous biopsy of the mass demonstrated recurrent clear cell RCC. At this point the tumor was thought to be unresectable due to concern about invasion of the IVC and/or liver.

How would you manage this patient?