How to cite: Taylor JM. Adjuvant Therapy for Advanced Renal Cell Carcinoma. Grand Rounds in Urology. September 19, 2025. Accessed Apr 2026. https://grandroundsinurology.com/adjuvant-therapy-for-advanced-renal-cell-carcinoma/
Summary
Jennifer M. Taylor, MD, MPH, Baylor College of Medicine, Houston, Texas, discusses adjuvant therapy for patients with high-risk, non-metastatic clear cell renal cell carcinoma (RCC) following nephrectomy. She explains that pembrolizumab is the only FDA-approved adjuvant treatment for this setting, based on the KEYNOTE-564 trial, which demonstrated significant improvement in disease-free and overall survival. Pembrolizumab is administered every three weeks for one year and should begin within twelve weeks of surgery for patients who are disease-free but remain at high risk of recurrence.
Dr. Taylor describes how pembrolizumab reduced the recurrence risk by 38%, with a sustained benefit over time. Subgroup analyses show particular benefit among patients with intermediate- to high-risk M0 disease. Programmed death-ligand 1 testing is not required for eligibility, but a benefit was observed across most risk categories. Adverse event rates were acceptable, with approximately 20% experiencing grade 3 or higher immune-related toxicity.
Dr. Taylor contrasts these findings with earlier adjuvant trials of tyrosine kinase inhibitors, which have failed to demonstrate a consistent survival benefit. She attributes this to toxicity-related discontinuation and over-enrollment of lower-risk patients. She reviews emerging biomarkers, including kidney injury molecule 1 and circulating tumor DNA, which may help identify patients most likely to benefit from adjuvant therapy.
In managing recurrence, Dr. Taylor notes that adjuvant pembrolizumab is now considered the standard of care for high-risk, non-metastatic RCC but underscores the need for validated biomarkers to minimize overtreatment and optimize patient outcomes.
About The 29th Annual Innovations in Urologic Practice:
Presented by co-chairs Mohit Khera, MD, MBA, MPH, and Michael Coburn, MD, FACS, the Innovations in Urologic Practice conference provides a detailed review and commentary on multiple genitourinary and urologic diseases. Among the featured oncological topics are bladder cancer and immunotherapies, as well as upper tract cancer management and prostate cancer, including state-of-the-art imaging, focal therapy, and MRI. Experts also discuss new tools and techniques for nephrectomy and treating advanced renal cell carcinoma. In terms of general urological approaches, the conference also includes pelvic reconstruction and trauma, men’s health topics like male infertility and sexual dysfunction, and ways to diagnose and treat infections in the urology patient.
For further educational activities from this conference, visit our collection page.
ABOUT THE AUTHOR
Jennifer M. Taylor, MD, MPH, is an associate professor of urology and a practicing urologist at Baylor College of Medicine in Houston, Texas where she also serves as the residency program director for urology. Additionally, Dr. Taylor practices at the Michael E. DeBakey VA Medical Center where she is the director of urologic oncology for the VA urology service. Dr. Taylor earned her MD from the University of Texas Medical School in Houston, where she also completed an internship and residency, and she completed a fellowship in urologic oncology at Memorial Sloan Kettering Cancer Center in New York City. She also earned an MPH from the Harvard T.H. Chan School of Public Health in Boston.
Dr. Taylor is involved in clinical research in multiple genitourinary malignancies, with a focus on bladder cancer, as well as in research on medical education and physician wellness and resilience. Dr. Taylor is involved in the national medical community and is a member of the American Urological Association, the Society of Urologic Oncology, the Society of Women in Urology, and the American College of Surgeons. She has won numerous awards, including Baylor College of Medicine’s Norton Rose Fulbright Faculty Excellence Award for Teaching and Evaluation and the Women of Excellence Award.
