(UroToday.com) At the 2021 European Association of Urology annual meeting Game Changing session, Dr. Tom Powles presented results of the KEYNOTE-564 trial evaluating pembrolizumab versus placebo as adjuvant therapy for patients with RCC. In 2018, kidney cancer was responsible for 175,000 deaths worldwide. Nephrectomy is the standard of care treatment for locoregional RCC, however, there is no globally accepted standard adjuvant therapy supported by high levels of evidence. Studies of adjuvant immunotherapy with cytokines have yielded negative results and VEGF-targeted therapy has not shown a consistent benefit in the adjuvant setting. Importantly, nearly half of patients eventually experience disease recurrence after surgery, with risk factors including tumor stage/size, nodal involvement, and nuclear grade. Patients with M1 stage and no evidence of disease after resection of oligometastatic sites are also at high risk of relapse.