Abstract: Renal cell carcinoma (RCC) is regarded as one of the most difficult malignant tumors to cure. A better understanding of the molecular mechanism of RCC has led to a dramatic paradigm shift in the treatment of patients with metastatic disease. In the past 20 years, a nonspecific immune approach using cytokines has beenemployed, but recently, with the development of new drugs and clinical experiments, targeted therapy for cancer has become a hot topic. Meanwhile, the treatment for RCC has developed to a molecular-targeted approach against vascular endothelial growth factor (VEGF) and related pathways. A large number of clinical trials have demonstrated favorable effects of targeted therapy on patients with metastatic RCC. Sorafenib andSunitinib were approved by the FDA to treat advanced RCC in the USA in 2005 and 2006, respectively. Thepurpose of this review is to summarize the current management of RCC and to discuss potential future directions in the treatment of metastatic RCC.