Following the demonstration of their remarkable efficacy in metastatic renal cell carcinoma (mRCC), antiangiogenic drugs are now being tested in adjuvant and neoadjuvant approaches. The combination of surgery and systemic therapy is increasingly thought to be the best therapeutic option in mRCC, even though the timing of surgery is still poorly defined. Neoadjuvant settings include mRCC for selecting responder patients, locally advanced renal cell carcinoma (RCC) for improving resectability, and localized RCC for allowing conservative approaches. Regardless of strategy, eventual drawbacks of neoadjuvant treatments are clinical progression or medical complications, thus delaying or preventing surgery, and perioperative morbidities. In this issue of European Urology, Chapin et al addressed the issue of safety of presurgical administration of antiangiogenic drugs through a large comparative series [1].
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