New drug combo shows promise for untreated kidney cancer

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * Biopsy/pathology-proven clear cell renal cell carcinoma (CCRCC) with metastases * Have an Eastern Cooperative Oncology Group (ECOG) performance status =\< 1 * Hemoglobin \>= 10 gm/dL * Absolute neutrophil count (ANC) \>= 1.5 x 10\^9/L * Platelets \>= 100 x 10\^9/L * Total bilirubin =\< upper limit of normal (ULN) * Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =\< ULN * International normalization ratio (INR) and activated partial thromboplastin time (aPTT) \< 1.2 x ULN * Serum creatinine \< 1.5 mg/dL or if serum creatinine \> 1.5 mg/dL then calculate creatinine clearance (CrCL) \> 30 mL/min * Urine protein to creatinine ratio =\< 1 (if urine protein creatinine ratio is \> 1, then a 24-hour urine total protein must be assessed; subjects will be ineligible if the 24-hour urine protein is found to be \> 1 gm) * Normal cardiac ejection fraction (\> 50%) by multi gated acquisition scan (MUGA) or echocardiogram * Have measurable disease per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria present * Ability to swallow and retain oral medication * Subjects of child-bearing potential must agree to use adequate contraceptive methods (e.g., hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation; should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately * Subject or legal representative must understand the investigational nature of this study and sign an Independent Ethics Committee/Institutional Review Board approved written informed consent form prior to receiving any study related procedure Exclusion Criteria: * Subjects with known brain metastases should be excluded from this clinical trial * Prior VEGF targeted therapies for renal cell carcinoma (RCC) including adjuvant or neoadjuvant treatments; in phase 1 only, one prior therapy with high dose IL-2 or anti-programmed cell death (PD)-1 compound alone or in combination with cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) targeting drug is allowed on the trial * Subjects diagnosed with another cancer in the past 3 years; excluding basal cell carcinoma or squamous cell carcinoma, of skin which were completely cured by resection * Concurrent use of another anti-cancer drug including an investigational anti-cancer agent * Major surgery within 28 days prior to treatment or major surgery planned during the next 6 months * Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic or psychiatric illness/social situations that would limit compliance with study requirements * History of any of the following cardio-vascular condition: * Myocardial infarction (MI) * Unstable angina * Coronary artery bypass grafting (CABG)-unless patient had a negative stress test within 6 months of screening * Coronary angioplasty or stenting * Symptomatic peripheral arterial disease (PAD) * History of symptomatic chronic congestive heart failure (CHF) * History of cerebrovascular accidents including transient ischemic attacks (TIA) * Corrected QT interval (QTc) \> 480 msec * Uncontrolled hypertension (systolic blood pressure \[BP\] \> 150 mm Hg or diastolic BP of \> 90 mm Hg); if the screening BP is elevated, adjustments in anti-hypertensives are permitted and a re-screening will be permitted for BP assessment with three consecutive values obtained 2 minutes apart; the 3 values have to be below 150/90 mm Hg for eligibility and can only be obtained after 2 days of the last change in anti-hypertensive medication; use of clonidine is not permissible for adjusting the BP during this period * History of deep vein thrombosis (DVT) or pulmonary embolism (PE) in the past 6 months * Subjects should not have packed red blood cells (PRBC) or platelet transfusion within 14 days of the screening * Evidence of active bleeding or bleeding disorder * Subjects currently on anti-coagulation therapy are not eligible * Unable to discontinue the use of prohibited medications * Pregnant or nursing female subjects * Unwilling or unable to follow protocol requirements * Any condition which in the investigator's opinion deems the subject an unsuitable candidate to receive study drug * Received an investigational agent within 30 days prior to enrollment