How would use of adjuvant pembrolizumab after nephrectomy for ccRCC impact your treatment choice for metastatic recurrence?

I think treatment selection after recurrence/metastases will depend on the timing after adjuvant pembrolizumab has been completed. If it's about 9 months or more, I think re-challenge with pure IO/IO combination is fair, especially if a patient tolerated pembrolizumab well. If it's within 3-6 months...

Adjuvant IO in RCC is an evolving field, with the adjuvant pembro data showing a DFS advantage and other large trials pending. Whether there will be an OS advantage and whether a subset of patients are cured with adjuvant pembro (versus only delaying recurrence) is yet to be determined. Nonetheless,...

Adjuvant use of pembrolizumab following nephrectomy will be an emerging phenomenon. Therefore, this is a very important question. I would propose that I would typically use cabozantinib as monotherapy in this setting, given the data we have for the agent post-immunotherapy. While there is no definit...