Clinical Research Directory

Inclusion Criteria: * Eastern Cooperative Oncology Group Performance Status (ECOG PS) of 0 or 1 * International Metastatic RCC Database Consortium (IMDC) risk intermediate (score of 1 or 2) or poor (score of 3-6) * Measurable disease with at least one measurable lesion * Histologically confirmed ccRCC with or without sarcomatoid features * Negative for HIV, hepatitis B, or hepatitis C virus (HCV) Exclusion Criteria: * Pregnant or breastfeeding, or intention of becoming pregnant during the study or within 90 days after the final dose of tiragolumab, 4 months after the final dose of tobemstomig (RO7249669) and pembrolizumab, or for 1 week after the final dose of axitinib, whichever occurs last * Inability to swallow a tablet or malabsorption syndrome * Prior treatment for localized and/or metastatic RCC with systemic RCC-directed therapy, including T-cell costimulating or immune checkpoint blockade therapies * Ongoing use or anticipated need for treatment with a strong CYP3A4/5 inhibitor or inducer * Major surgical procedure, other than for diagnosis, within 4 weeks prior to initiation of study treatment, or anticipation of need for a major surgical procedure during the study * Uncontrolled or symptomatic hypercalcemia or symptomatic hypercalcemia requiring continued use of bisphosphonate therapy or denosumab * Symptomatic, untreated, or actively progressing central nervous system (CNS) metastases * History of leptomeningeal disease * Uncontrolled tumor-related pain * Uncontrolled pleural effusion, pericardial effusion, or ascites requiring recurrent drainage procedures (once monthly or more frequently) * Moderate to severe hepatic impairment (Child-Pugh B or C) * Uncontrolled hypertension * Prior history of hypertensive crisis or hypertensive encephalopathy * Significant cardiovascular/cerebrovascular disease within 3 months (12 months for UK participants) prior to randomization * History of clinically significant ventricular dysrhythmias or risk factors for ventricular dysrhythmias * History of congenital QT syndrome * Resting heart rate (HR) \> 100 bpm (or clinically significant tachycardia) * Stroke (including transient ischemic attack), myocardial infarction, or other symptomatic ischemic event, or thromboembolic event (e.g., deep venous thrombosis \[DVT\], pulmonary embolism \[PE\]) within 3 months (12 months for UK participants) before randomization * Significant vascular disease (e.g., aortic aneurysm or arterial dissection requiring surgical repair or recent peripheral arterial thrombosis) within 6 months prior to Day 1 of Cycle 1 * Tumors invading pulmonary blood vessels, cavitating pulmonary lesions or known endobronchial disease * Tumor invading the gastrointestinal (GI) tract, including abdominal or tracheoesophageal fistulas * Evidence of abdominal free air not explained by paracentesis or recent surgical procedure * Active peptic ulcer disease, acute pancreatitis, acute obstruction of the pancreatic or biliary duct, appendicitis, cholangitis, cholecystitis, diverticulitis, gastric outlet obstruction * Intra-abdominal abscess within 6 months before initiation of study treatment * Clinical signs or symptoms of GI obstruction or requirement for routine parenteral hydration, parenteral nutrition, or tube feeding * Evidence of bleeding diathesis or significant coagulopathy * Grade ≥ 3 hemorrhage or bleeding event within 28 days prior to initiation of study treatment * Clinically significant hematuria, hematemesis, hemoptysis of \> 0.5 teaspoon (2.5 mL) of red blood, coagulopathy, or other history of significant bleeding (e.g., pulmonary hemorrhage) within 3 months before initiation of study treatment * Active or history of autoimmune disease or immune deficiency * Treatment with systemic immunosuppressive medication within 2 weeks prior to initiation of study treatment, or anticipation of need for systemic immunosuppressive medication during study treatment * Prior allogeneic stem cell or solid organ transplantation * History of idiopathic pulmonary fibrosis, organizing pneumonia (e.g., bronchiolitis obliterans), drug-induced pneumonitis, or idiopathic pneumonitis, or evidence of active pneumonitis on screening chest computed tomography (CT) scan * History of another primary malignancy other than RCC within 2 years prior to screening, with the exception of malignancies with a negligible risk of metastasis or death (e.g., 5-year OS rate \> 90%) * Administration of a live, attenuated vaccine within 4 weeks before randomization or anticipation that such a live, attenuated vaccine will be required during the study * Active tuberculosis (TB) * Severe infection within 4 weeks prior to initiation of study treatment * Participants with active Epstein-Barr virus (EBV) infection or known or suspected chronic active EBV infection at screening * Treatment with therapeutic oral or IV antibiotics within 2 weeks prior to initiation of study treatment * Known hypersensitivity to Chinese hamster \*ovary cell products or to any component of tobemstomig, tiragolumab, pembrolizumab, or axitinib