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

Inclusion Criteria: * Provision to sign and date the consent form. * Stated willingness to comply with all study procedures and be available for the duration of the study. * Participant self-identified gender ages \>/= 18 years old is acceptable and appropriate if they meet other inclusion criteria. * Histologically proven clear cell component RCC. * An upfront candidate for definitive surgery per treating Urologist. * Suitable for and willing to undergo nephrectomy (either cytoreductive or with curative intent) per treating urologist. * T Stage of any of the following: cT3b, cT3c, cT4 * N stage of any of the following: cN0 or cN1 * M stage of any of the following: cM0 or cM1 * ECOG performance status 0 - 2. * Urinalysis \<2+ protein. If dipstick is ≥2+ then a 24-hour urine collection should be performed, and the patient may enter the trial if urinary protein is \<2g per 24 hours. * All participants who have reproductive potential must have a negative serum or urine pregnancy test within a maximum of 14 days prior to starting trial treatment. Reproductive potential is defined as the following: * Women will be considered post-menopausal if they have been amenorrheic for 12 months without an alternative medical cause. The following age-specific requirements apply: * Women \<50 years of age would be considered post-menopausal if they have been amenorrheic for 12 months or more following cessation of exogenous hormonal treatments and if they have luteinizing hormone and fol…