The Continuing Question of Adjuvant Therapy in Clear Cell Renal Cell Carcinoma

SIMPLE SUMMARY: Treatment options after radical nephrectomy for clear cell renal cell carcinoma (ccRCC) have been studied extensively in large randomized clinical trials. Currently, two therapies are approved for patients to receive for one year: pembrolizumab or sunitinib. Newer advances are being developed to help select patients, since approved therapies can cause toxicity. The aim of our review is to discuss past and recent clinical trials that led to the current approvals and upcoming methods for ideal patient selection. ABSTRACT: Treatment advances in kidney cancer continually evolve. The focus of treatment options continues with oral vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKIs) or intravenous immune checkpoint inhibitors (ICIs). Multiple trials exploring the role of adjuvant treatment after cytoreductive nephrectomy in high-risk clear cell renal cell carcinoma are currently ongoing. The discovery of biomarkers may help determine which patients benefit from these treatments, but these are not yet available outside clinical studies. Trials with combination therapies are also ongoing, especially using novel therapies with new mechanisms of action, and will hopefully provide more clues on proper patient and therapy selection in the adjuvant setting.