To the Editor Improving outcomes in patients with renal cell carcinoma (RCC) with brain metastases remains a major challenge.1 Systemic treatment should be considered a crucial component of care, considering that most of these patients will harbor distant metastases outside the central nervous system, and brain metastases at diagnosis confer a dismal prognosis.2 In JAMA Oncology, Hirsch and colleagues3 reported the results of a cohort study of cabozantinib for patients with RCC with progressing brain metastases without concomitant brain-directed local therapy (cohort A) or with stable or progressing brain metastases concomitantly treated by brain-directed local therapy (cohort B). Many objective partial responses in the brain were noted, and median overall survival was 15 months and 16 months in cohorts A and B, respectively. Although this was a relatively small cohort study, these data are relevant to clinical practice, and the trial by Hirsch et al3 represents an interesting piece of work in this setting.