 Good morning ladies and gentlemen. My name is Manoela Schmidinger. I'm a medical oncologist working at the University in Vienna, and it's my great pleasure to welcome you to day two of the 9th European and International Kidney Cancer Symposium. We're going to have very interesting sessions today as well. The sessions yesterday, I believe, were already very well received, and I hope you also had the opportunity to enjoy the beauty of Dublin and to have a few pints of beer, of Guinness. So I have an important announcement for you that is relevant for all of those who are going back today. We have decided to cut down the lunch break, so we will be here from, we will have lunch break from 12 20 to 120, and we will meet back in the room at 1.30. So we plan to finish the symposium today at 3 p.m. So please bear this in mind, this in mind that we are going to come back earlier from lunch, and now it's my great pleasure to open the first session which will be chaired by John Hannon and myself, and it's going to be on systemic treatment of renal cell cancer. Thank you very much, Manoela. My name is John Hannon. I'm a medical oncologist at the Netherlands Cancer Institute in Amsterdam. I will be chairing this session. So before starting this session about metastatic renal cell cancer treatment by systemic treatment, I would like to ask for two questions that I would like to discuss with you this morning before we have the first speaker. So the first question is about patient one, a 60-year-old male present, presents with right flank pain and nausea. Further, he has no other complaints. His blood pressure is 120 over 80, and no abnormalities are recorded. His eco-performance status is zero. Looking at laboratory results, their normal CT chest abdomen shows an 8-centimeter right renal mass and bilateral pulmonary nodes from 1.5 to 2.5 centimeters. Bone scan, CT scan of the brain are normal, and he underwent a right nephrectomy, and the histology showed predominantly clear cell renal saccharcinoma. At follow-up visit in eight weeks, he still has a very good performance status, but his chest CT scan shows progression of pulmonary nodes and also a new lesion in his right lung. His labs are still okay, normal hemoglobin, normal platelet count, snoot fills, calcium is normal, and he has a slight elevated keratin in his bilirubin acid and ALT hour within the normal range. So the question, which of the following treatment alternatives would you recommend to this patient? Continued observation, one, synitinib treatment, pazopinib, devosuzumop, combined with interferon if necessary, high dose interleukin-2, an mTOR-nebiter, for example, temsural liners, or clinical trial. And that should be seven, I think. So you can answer now. Okay. So the majority of you chose synitinib. I think synitinib is still the drug that is mostly used in first line, and that's clearly also the case here. Thank you very much. We go to the second question. This is a 54-year-old woman with a history of nephrectomy for left renal mass, 7.5 centimeters, seven months previously. Histology shows a grade four, clear saccharcinoma, sacromortoid areas, less than 25 percent, and she presents with weight loss, bilateral chest pains, has a good performance status, and normal blood pressure. She feels chronically ill, but has no further abnormalities. CT scans of chest and abdomen show bilateral two-centimeter pulmonary nodules and a lesion in the liver of 2.5 centimeters. Her CT scan of the brain is normal. Bone scans show bilateral areas increase uptake in the ribs. She has an anemia with hemoglobin of 6.2 millimole per liter. She has elevated platelet counts, normal neutrophils, and elevated LDH. Calcium is normal, creatinine is slightly elevated, but the liver function tests are normal. So again, which treatment option would you recommend for this patient? Symptom care only? Two, synidinib, three, pazopinib, four, bevacizumab plus interferon, amtornhibitor, or anything else? You can answer now. Can we have the music? Very consistent. Most of you will choose again for synidinib. Now a little bit more people also will give pazopinib and amtornhibitor, because this is a porous patient. Very nice. So what we would like to do this morning is discuss the several drugs that are available. We'll start with Camilo Porta from the Zamarteo University in Pavia in Italy. And he's going to discuss who is your ideal synidinib patient.