Which patients with intermediate or high-risk RCC after nephrectomy do you offer adjuvant immunotherapy?

Patients with clear cell RCC who have T2 G4, T3 or T4, N1, and M1, resected to NED have level 1 evidence of improvement in DFS with pembro (HR 0.68 in the initial study). Going beyond pembro- belzutifan can further improve DFS (0.72). The OS benefit with pembro is also 0.7 but there is a question of...