Perioperative therapies for metastatic renal cell carcinoma

Systemic therapy for metastatic renal cell carcinoma (mRCC) has advanced considerably over the past decade. Studies of systemic therapies in the adjuvant, neoadjuvant, and now perioperative settings as solitary, dual, and triplet combinations are underway. The timing of systemic therapy relative to extirpative surgery has yielded varying results. With the rise of novel therapeutics, new methods for risk stratification and patient selection, including initial biomarker evaluation, have begun. This perspective aims to summarize investigations into perioperative mRCC therapies and discuss the foundations of these concepts based on recent adjuvant and neoadjuvant trials, and to discuss future directions in this space.