Perioperative Lenvatinib With Pembrolizumab in Patients With Locally Advanced Nonmetastatic Clear Cell Renal Cell Carcinoma

Inclusion Criteria: * Patients with a renal mass consistent with a clinical stage \>= T3Nx or TanyN+ or deemed unresectable by surgeon * Renal cell carcinoma with clear cell component on pre-treatment biopsy of the primary tumor * The participant (or legally acceptable representative if applicable) provides written informed consent and the willingness and ability to comply with all aspects of the protocol * Have an Eastern Cooperative Oncology Group (ECOG) performance status =\< 1 * Absolute neutrophil count (ANC) \>= 1500/uL (specimens must be collected within 72 hours prior to the start of study treatment) * Platelets \>= 100 000/uL (specimens must be collected within 72 hours prior to the start of study treatment) * Hemoglobin \>= 9.0 g/dL (specimens must be collected within 72 hours prior to the start of study treatment) or ≥5.6 mmol/La Renal: Creatinine =≤1.5 × ULN OR Measured or calculatedb creatinine clearance (GFR can also be used in place of creatinine or CrCl)=≥30 mL/min for participant with creatinine levels \>1.5 × institutional ULN. Hepatic: Total bilirubin=≤1.5 ×ULN OR direct bilirubin ≤ULN for participants with total bilirubin levels \>1.5 × ULN AST (SGOT) and ALT (SGPT)=≤2.5 × ULN (≤5 × ULN for participants with liver metastases) Coagulation: International normalized ratio (INR) OR prothrombin time (PT) Activated partial thromboplastin time (aPTT)=≤1.5 × ULN unless participant is receiving anticoagulant therapy as long as PT or aPTT is within therapeuti…