Neoadjuvant Pembrolizumab and Axitinib in Renal Cell Carcinoma With Inferior Vena Cava Tumor Thrombus

This study is testing whether giving immunotherapy (pembrolizumab) and a targeted drug (axitinib) before surgery can improve outcomes for people with kidney cancer (renal cell carcinoma) that has grown into a major blood vessel called the inferior vena cava, forming a tumor thrombus (blood clot-like tumor). This kind of kidney cancer is typically very challenging to treat. The study aims to see if shrinking the tumor before surgery makes the operation safer and more effective. **You may be eligible if...** - You are 18 years or older with a confirmed diagnosis of clear cell kidney cancer - Imaging shows your cancer extends into the inferior vena cava (T3b, T3c, or T4 staging) - You are a candidate for surgery to remove the kidney (nephrectomy) as determined by your urologist - Your overall health and organ function are adequate for treatment - You have a negative pregnancy test if applicable **You may NOT be eligible if...** - You have significant autoimmune conditions requiring ongoing immunosuppressive treatment - You have severe cardiovascular problems or recent heart events - You have excessive protein in your urine (above study threshold) - You are pregnant or breastfeeding Talk to your doctor to see if this trial is right for you.