Best therapy options for mets?

My step-father was diagnosed with renal cancer with mets to the bone, lungs, and regional lymph nodes a week ago. He had a radical nephrectomy three days ago to remove a 7cm tumor along with his entire right kidney. We do not have the pathology report back yet (we expect it hopefully by next Tuesday) because we are in Northern Idaho in a small hospital.

I live in the Portland, Oregon area and after a few days of solid research, I began feeling that the prognosis was not good with traditional therapies, and especially in an area lacking top-notch medical care. I have reached out to OHSU's Knight Cancer Institute where the area's leading kidney cancer oncologist also leads clinical trials on novel immunotherapy options, specifically Pembro. 

Yesterday, my mother and step-father met with the local oncologist and he indicated a number of interesting things that are making me wonder what the best approach is. He said that although the cancer has metastitisized, he does not consider it advanced and believes it to have recently spread. He believes my step-father has a strong chance for complete recovery given the newest modeications now available. He also indicated that Pembro is a really remarkable drug, but that we don't necessarily need a clinical trial to use it for RCC. He indicated he could get Pembro (Keytruda) directly from the manufacturer. 

I would like the persepective and advice from the real life experts on this site for the following questions:

• Has anyone had experience with an oncologist prescribing a therapy off-label and did this present difficulties with insurance coverage for the prescription?
• Has anyone been prescribed combination therapy using a signal transduction inhibitor and a monoclonal antibody like Pembro?
• Is it advisable to bring my step-father out to Portland, and if so should we plan to relocate them temporarily there with me (I have room) or is it realistic to think they may just need to come out for intermittent visits to receive therapy? We are a six hour drive or a one hour flight apart. 
• With all the new immunotherapy options out there, I'd like to know which types (Cytokines, monoclonal antibodies, etc.) people are seeing positive response from, as well as if anyone is using a combination therapy and if it is well tolerated. I understand we cannot be giving medical advice or prescribing therapies, but understanding what is currently considered cutting edge and what is old news would help. My eyes are beginning to cross from reading all of the preclinical studies and trial results!

Thank you in advance for any advice you can give us. I've been greatly moved after reading through so many of your threads and have found the positive support system here to be the most helpful resource I have found to date. Wishing you all the very best!