Fig. 1: Combination of ICT plus surgery is safe and feasible in the metastatic setting.

a Schema for clinical trial NCT02210117. Patients with mccRCC underwent baseline tumor biopsy and blood sample collection before being randomly assigned to receive nivolumab (nā=ā30), nivolumab + bevacizumab (nā=ā45), or nivolumab + ipilimumab (nā=ā30) for a total of 6 weeks. Four to six weeks after the ICT treatment, based upon evaluation by medical oncologists and urologists specialized on RCC, patients underwent either cytoreductive surgery or tumor biopsy. Two to four weeks after cytoreductive surgery or biopsy, nivolumab was given as maintenance therapy to each patient for up to 2 years or until disease progression or intolerable toxicities or withdrawal from the protocol. Tissue and blood samples were collected at pre-ICT treatment and at the time of surgery or biopsy (4ā6 weeks after the initial 6 weeks of ICT treatment) for correlative studies. b Overall survival (OS) in Arm A (nivolumab). c OS in Arm B (nivolumab + bevacizumab). d OS in Arm C (nivolumab + ipilimumab).