 BACKGROUND Sunitinib, SUTENT, is a promising multi-target TKI in the treatment of metastatic renal cell carcinoma after cytokine failure. In previous phase II studies, ORR is 40 and TTP 8,7 months. A phase III randomized trial of Sunitinib versus interferon alpha as first-line therapy for patients with mRCC showed a significantly longer PFS in the Sunitinib group 11 months than in the interferon group 5 months, hazard ratio of 0.42 95 CI, 0.32 to 0.54, p 0.001. Initial approval in second line treatment of mRCC was extended to first line therapy on 11-01-2007. 