Targeted agents have changed the treatment paradigm for advanced renal cell carcinoma (RCC).  Approved agents with demonstrated efficacy are sunitinib, sorafenib, pazopanib, bevacizumab, temsirolimus and everolimus.  However, there is an unmet need for new agents that improve clinical outcomes in treatment-naïve patients, as well as in those with disease refractory or intolerant to traditional and targeted therapies.  Many novel targeted agents, some of which have different mechanisms of action than approved agents, and immunomodulatory agents are currently in development for RCC.

Although many agents are approved or in development for RCC, comparative effectiveness data is lacking.  Ongoing and future head-to-head trials using comparators are essential for updating treatment guidelines for RCC.  Future research should be aimed at identifying agents that improve patient outcomes and have decreased toxicity compared with currently approved agents, with the goal of complete remission.