Inclusion Criteria:

- Histologic diagnosis of metastatic renal cell carcinoma

- Eligible to receive first-line sunitinib

- Willingness to attend Cross Cancer Institute and University of Alberta for
study-related assessments

- Karnofsky Performance Status (KPS)82 ≥ 70

- Age ≥ 18 years of age

- Adequate creatinine clearance to receive gadolinium

- All patients with bone metastases are eligible; those with lesions identified at
weight-bearing bones will undergo plain films to evaluate fracture risk prior to
CPET;

- Fluent in English language

- No contraindication to MRI or other concern eg., metallic implants, claustrophobia

Exclusion Criteria:

- Prior systemic therapy for mRCC

- Documented history of major cardiac event in last year i.e. MI, unstable angina,
CABG, symptomatic CHF, CVA or TIA, or pulmonary embolism

- Pregnancy

- Other severe condition or abnormality that, in the judgement of the investigator or
treating oncologist, would make participation in this study inappropriate

- Unstable brain metastases