局部肾细胞癌（RCC）主要采用肾切除术进行管理，此术式的目的是为了治疗。但是，大约20%的病人会出现疾病复发。手术后使用辅助治疗的方法，目的是通过干扰微转移过程（这些过程统称为转移级联反应）的形成、成熟或存活，从而治愈更多的患者。免疫检查点抑制剂和以血管内皮生长因子受体（VEGFR）为靶点的酪氨酸激酶抑制剂（TKI）在转移性RCC的治疗中已经显示出疗效，这增加了这些药物在辅助治疗中的应用的兴趣。Pembrolizumab是一种PD1免疫检查点抑制剂，现在已经获得FDA批准，并正在欧洲监管机构的审批中，用于局部切除的清明细胞RCC的辅助治疗，这是基于KEYNOTE-564试验的结果。然而，免疫治疗和VEGFR靶向TKI的最佳用法还不完全清楚。这些药物在多个步骤中干扰转移级联反应，为进一步研究这些治疗的应用提供了生物学基础。正在进行评估辅助治疗在RCC中的临床试验，并且临床考虑必须指导在局部切除的RCC的免疫治疗和TKI药物在辅助治疗中的实际使用。©2022年Springer Nature Limited。

Localized renal cell carcinoma (RCC) is primarily managed with nephrectomy, which is performed with curative intent. However, disease recurs in ~20% of patients. Treatment with adjuvant therapies is used after surgery with the intention of curing additional patients by disrupting the establishment, maturation or survival of micrometastases, processes collectively referred to as the metastatic cascade. Immune checkpoint inhibitors and vascular endothelial growth factor receptor (VEGFR)-targeting tyrosine kinase inhibitors (TKIs) have shown efficacy in the treatment of metastatic RCC, increasing the interest in the utility of these agents in the adjuvant setting. Pembrolizumab, an inhibitor of the immune checkpoint PD1, is now approved by the FDA and is under review by European regulatory agencies for the adjuvant treatment of patients with localized resected clear cell RCC based on the results of the KEYNOTE-564 trial. However, the optimal use of immunotherapy and VEGFR-targeting TKIs for adjuvant treatment of RCC is not completely understood. These agents disrupt the metastatic cascade at multiple steps, providing biological rationale for further investigating the applications of these therapeutics in the adjuvant setting. Clinical trials to evaluate adjuvant therapeutics in RCC are ongoing, and clinical considerations must guide the practical use of immunotherapy and TKI agents for the adjuvant treatment of localized resected RCC.© 2022. Springer Nature Limited.