CTLA4 and renal cell adenocarcinoma: Conversely, patients with end-stage local RCC or metastatic RCC are treated with systemic therapy, including immune checkpoint inhibitors such as nivolumab and pembrolizumab, which target PD-1; avelumab and atezolizumab, which target PD-L1; ipilimumab, which targets CTLA-4; axitinib, sunitinib, pazopanib, and bevacizumab, which target vascular endothelial growth factor (VEGF); and the mTOR inhibitor everolimus [15].