Renal cell carcinoma is highly resistant to radiotherapy, and immunotherapy is the standard of care for metastatic renal cell carcinoma (MRCC), but with very limited efficacy. The introduction of molecularly targeted drugs has greatly improved this situation. In recent years, with the advancement of research and the introduction of new molecularly targeted drugs, the treatment of tumors has entered the era of molecular targeting. The breakthroughs in targeted drugs for the unique pathogenesis of renal cell carcinoma (RCC) were marked by the FDA’s approval of sorafenib and sunitinib for the treatment of MRCC in December 2005 and January 2006, respectively, and by June 2009, the FDA had approved sunitinib (sotan), sorafenib (doxorubicin), bevacizumab in combination with interferon-alpha (IFN-α), and bevacizumab in combination with doxorubicin. α (IFN-α), sirolimus and everolimus for the treatment of advanced kidney cancer, while clinical studies with axitinib and pazopanib (small molecule targeted drugs) as second-line treatment regimens have also yielded better results. 1. Sunitinib malate capsule. Sotan is a novel small molecule multi-targeted oral therapeutic drug with dual anti-tumor effects, both strong anti-angiogenic effects and inhibition of tumor cell proliferation. Sotan has a central position in the field of advanced renal cell carcinoma treatment and is the only therapeutic drug that breaks through the 2-year survival period of advanced renal cancer. Pharmacological effects: Sotan inhibits multiple receptor tyrosine kinases (RTK), some of which are involved in tumor growth, pathological angiogenesis and tumor metastasis. Sotan inhibits the activities of platelet-derived growth factor receptors, vascular endothelial growth factors (VEGFR1, VEGFR2 and VEGFR3), stem cell factor receptor (KIT), Fms-like tyrosine kinase 3 (FLT3), colony-stimulating factor receptor type 1 (CSF-1R) and glial cell-derived neurotrophic factor receptor (RET), and its major The main metabolites are similar to sunitinib activity. Dosage: The recommended dose for the treatment of advanced renal cell carcinoma is 50 mg orally once daily for 4 weeks and 2 weeks off (4/2 dosing regimen). It can be taken with or without food. Efficacy: Overall, it is effective in about 90% of kidney cancer patients. A few of the effective patients can make the lesions disappear, and some of them can make the lesions smaller or the tumors remain stable during the course of drug administration. Adverse effects: most common: fatigue, loss of appetite, nausea, diarrhea, some patients can also have leukocytopenia and thrombocytopenia, hand-foot syndrome, etc. Most of the adverse effects are not serious and can be treated. 2, Sorafenib tosylate Sorafenib is a novel diaryl urea with the chemical name 4-{4-[3-(4-chloro-3-(trifluoromethyl)-phenyl)- acylurea]-phenoxy}-pyridine-2-carboxylic acid methanamine, clinically used as the tosylate of sorafenib. Sorafenib is an oral multi-kinase inhibitor jointly developed by Bayer and ONYX, which has the effect of targeting and inhibiting tumor cell proliferation and tumor angiogenesis. Sorafenib takes a “multi-target” approach to attack tumor cells by inhibiting the receptor tyrosine kinases KIT and FLT-3 upstream and serine-threonine kinases in the RAF/MEK/ERK pathway downstream to reduce tumor cell proliferation, and by inhibiting the receptor tyrosine kinases VEGFR and PDGFR upstream to reduce tumor cell proliferation. VEGFR and PDGFR, as well as downstream inhibition of serine-threonine kinases in the RAF/MEK/ERK pathway, reduces tumor angiogenesis. The recommended dose of sorafenib is 0.4g (2 x 0.2g) twice daily on an empty stomach or with a low or medium fat diet. Take orally, swallowed with a glass of warm water. Several foreign studies have demonstrated the efficacy of sorafenib in the treatment of advanced RCC. Because sorafenib selectively targets tumor cells, it has milder adverse effects than traditional chemotherapy drugs, which facilitates long-term use by patients. The Chinese dosing study of sorafenib for advanced RCC was conducted by four research centers, including the Department of Medical Oncology, Chinese Academy of Medical Sciences, Department of Urology, Peking University First Hospital, Department of Medical Oncology, Wuhan Tongji Hospital, and Department of Chemotherapy, Zhejiang Cancer Hospital. The study results showed that the disease control rate reached 84.21% and the median disease-free period was 42 weeks, which was twice as long as that of the placebo group. Common adverse reactions were skin reactions in the hands and feet, hypertension, diarrhea, rash, alopecia, pruritus, nausea and loss of appetite. This study indicates that sorafenib can effectively control disease progression in Chinese patients with advanced RCC and has a good safety profile. 3. Other targeted drugs Bevacizumab combined with IFN is still the first-line treatment option for mRCC. Everolimus Everolimus, an oral mTOR inhibitor, has recently been recommended by the National Comprehensive Cancer Network (NCCN) Kidney Cancer Clinical Practice Guidelines as a second-line treatment after failure of VEGF/TKI, and patients who have failed treatment with sunitinib, sorafenib and bevacizumab can switch to everolimus. Adverse effects are mainly hematological toxicity and biochemical abnormalities, mucositis and fatigue.