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The remarkable progress in the treatment of metastatic renal cell carcinoma (mRCC) with antiangiogenics and immunotherapy has yet to be translated to the adjuvant space, where opportunity exists for improving overall survival (OS) in patients with high risk of relapse following radical nephrectomy. In this setting, RCC trials have been hampered repeatedly by negative results [1, 2]. Unfortunately, up to 40% of RCC patients diagnosed with locoregional disease will have a relapse after nephrectomy [3]. The S-TRAC trial has shown that sunitinib, a Vascular Endothelial Growth Factor Receptor-Tyrosine Kinase Inhibitor (VEGFR-TKI), may provide clinical benefit, improving disease-free survival (DFS) compared to placebo in RCC patients at high risk for recurrent disease [4]. This study provides the first evidence that targeting the VEGF pathway may help to delay the recurrence in RCC. However, these results are not definitive since survival data are not mature yet. Adjuvant treatments often have this feature: the purported benefit must usually be inferred long before it is experienced. If the intermediated endpoint (in this instance, DFS) is validated, then earlier and adequate decisions are possible. If not, treatment may confer risks far greater than any expected benefits.

Adjuvant Sunitinib for Renal Cell Carcinoma: Still at the Beginning of the Road