Treatment selection is difficult in metastatic renal cell cancer. It is based mainly on tumour histology and biologic behaviour, patients characteristics such as comorbidities and performance status, and expected treatment toxicity.
Several recently published studies have identified prognostic factors for patients treated with targeted agents including sunitinib, sorafenib, pazopanib, bevacizumab, temsirolimus, and everolimus. These prognostic factors should be considered when selecting the treatment strategy.