Cytotoxic chemotherapy is unlikely to be a curative modality for the majority of advanced solid tumor malignancies.Targeted therapy has the benefit of affecting tumor cell pathways more specifically by using the overexpression of specific markers in tumor ceils, to an advantage.For more than a decade, the only agent approved in the use of metastatic renal cancer was Interleukin-2.The reason for the approval was that it produced prolonged remissions in about 8-10% of the patients treated.However the therapy is extremely toxic and only 10-20% of renal cancer patients are eligible to receive it.Since 2005, there are three targeted therapies that are FDA approved in the United States for clinical use in metastatic renal cancer; sunitinib [VEGF, PDGF and TGF inhibitor], sorafenib [raf-kinase inhibitor] and temsirolimus [M-TOR inhibitor].Due to the predominant VEGF pathway dependent proliferation of kidney cancer, it has been a model for proof of principle of the efficacy of antiangiogenic therapy.However, with the mnlti-factorial etiology of tumors, it would be naive to assume that each agent would produce a durable antiproliferative effect as a single agent.Combinations of different targeted anti-tumor agents are worthy of investigation, to make further progress in therapeutics of kidney cancer.