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Adjuvant immunotherapy for renal cell carcinoma: understanding complexity, embracing uncertainty, making a difference

Nature Reviews Urology (2026) Cite this article

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The approval of pembrolizumab as adjuvant immunotherapy for patients with clear cell renal cell carcinoma meeting the KEYNOTE-564 criteria set new standards and recalibrated future research and clinical needs. Yet, clinical decisions are becoming increasingly nuanced. Achieving clarity in this setting requires a cultural shift aimed at balancing evidence and uncertainty. As a community we should consider this tension as an opportunity to improve on value for patients.

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Fig. 1: Care in the adjuvant therapy setting according to tumour aggressiveness in patients with ccRCC meeting the KEYNOTE-564 criteria.
The alternative text for this image may have been generated using AI.

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Author information

Authors and Affiliations

  1. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy

    Riccardo Campi

  2. Unit of Urology and Renal Transplantation, Oncology Department, Careggi University Hospital, Florence, Italy

    Riccardo Campi

  3. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria

    Riccardo Campi

  4. Department of Oncology, University of Turin, Orbassano, Italy

    Daniele Amparore

  5. Division of Urology, Department of Surgery, Candiolo Cancer Institute FPO-IRCCS, Candiolo, Italy

    Daniele Amparore

  6. Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy

    Carlotta Palumbo

  7. Skin and Renal Units, The Royal Marsden NHS Foundation Trust, London, UK

    Laura Marandino

  8. Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China

    Zhenjie Wu

  9. Department of Urology, AZ Delta, Roeselare, Belgium

    Eduard Roussel

  10. Department of Urology, Leonardo Hospital Group, Saint Camillus International University of Health Sciences - Unicamillus, Abano Terme, Italy

    Michele Marchioni

  11. Department of Urology, University of L’Aquila, L’Aquila, Italy

    Savio Domenico Pandolfo

  12. Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, Naples, Italy

    Savio Domenico Pandolfo

Authors
  1. Riccardo Campi
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  2. Daniele Amparore
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Consortia

on behalf of the European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer working group

  • Daniele Amparore
  • , Riccardo Campi
  • , Carlotta Palumbo
  • , Laura Marandino
  • , Zhenjie Wu
  • , Eduard Roussel
  • , Michele Marchioni
  •  & Savio Domenico Pandolfo

Corresponding author

Correspondence to Riccardo Campi.

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Competing interests

R.C. has received honoraria for advisory roles and travel grants from Telix Pharmaceuticals, Ipsen and MSD. D.A. declares no competing interests.

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Campi, R., Amparore, D. & on behalf of the European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer working group. Adjuvant immunotherapy for renal cell carcinoma: understanding complexity, embracing uncertainty, making a difference. Nat Rev Urol (2026). https://doi.org/10.1038/s41585-026-01146-7

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