Adjuvant Immunotherapy for Kidney Cancer — A New Strategy with New Challenges

Surgery with curative intent constitutes the standard of care for patients with advanced renal-cell carcinoma, yet more than 50% of patients with high-risk features will have disease recurrence. Two agents have been approved by the Food and Drug Administration (FDA) for adjuvant use after nephrectomy on the basis of a disease-free survival benefit observed in randomized, placebo-controlled trials: sunitinib, an oral tyrosine kinase inhibitor; and pembrolizumab, a programmed death 1 (PD-1)–directed monoclonal antibody. Adjuvant use of sunitinib has not been integrated into routine care, owing largely to challenges around toxic effects and a lack of a proven benefit with regard . . .