Bobbie,
I'm 39 years old and was diagnosed with sarcomatoid rcc in January of this year; I too was stage IV with mets in the adrenal gland, lymph nodes, and lungs. I've been treated at MD Anderson with Avastin, Gemzar, Adrimycin, Sutent, Xeloda, and Interferon (which I didn't tolerate). The cancer has progressed but not nearly as fast as doctors expected given the aggressive nature of my cancer. I will go on a clinical trial starting next week, that combines the approved drug Nexavar (Sorafenib) with and experimental drug, AMG 386.
Best of luck to your nephew!
Tony