Renal cell carcinoma (RCC) is the most common type of kidney cancer, and its incidence has been gradually increasing in recent years. more than 500 patients with kidney tumors were admitted to our department in 2012. From foreign studies, about 30% of patients had distant metastasis at the time of diagnosis, about 40% of patients had recurrent metastasis after surgery, and kidney cancer is mostly insensitive to radiotherapy and chemotherapy. In December 2005, FDA officially approved Sorafenib for the treatment of advanced kidney cancer, and the treatment of advanced kidney cancer has entered the era of molecular targeted therapy. So far, there are 7 molecular targeted drugs approved by FDA for the treatment of mRCC: sunitinib, pazopanib, sorafenib, bevacizumab, tesilomox, everolimus and axitinib; only 2 of these 7 targeted drugs, sunitinib and sorafenib, have been marketed in China, while everolimus and axitinib may be marketed one after another in the near future. Patients in China should have an understanding of the efficacy and side effects of the above four drugs, and the basic principles of targeted drug therapy, and work with your primary care physician to choose the right targeted drug for you, in order to achieve the best therapeutic effect. Efficacy and side effects of commonly used drugs 1.Sotan (sunitini, Sutent) A multinational multicenter phase III randomized clinical trial confirmed the efficacy of sotan instead of a interferon as the first-line treatment for advanced kidney cancer. The trial enrolled 750 patients with advanced kidney cancer randomized to receive sunitini or a interferon, with the primary study endpoint of PFS. data showed that the median PFS was significantly longer in the sunitini group than in the a interferon group (11 vs. 5 months; P<0.001), and ORR was significantly higher (47% vs. 12%; P<0.000001), with OS of 26.4 months and 21.8 months (P=0.051). The domestic phase IV clinical study of sotan showed superior results in Chinese with a median PFS of 14.2 months and a median OS of 30.7 months. Toxic side effects: The incidence of grade III and IV adverse reactions were 6-17% for hand and foot skin reactions, 4-9% for diarrhea, 8-12% for hypertension, 10-23% for thrombocytopenia, 15-18% for neutropenia, and 2-3% for decreased cardiac ejection fraction. 2, sorafenib (doxorubicin sorafenib) sorafenib (sorafenib) for metastatic kidney cancer multi-center, randomized controlled phase III clinical study (TARGET) showed that compared with placebo, sorafenib significantly prolonged median disease-free progression survival in patients with metastatic kidney cancer (pro- gressfreesurvival (PFS) (5.5 months versus 2.8 months, P<0.01) and significantly prolonged overall survival (OS) (17.8 months versus 14.3 months, P=0.0287). The most common grade III and IV adverse reactions included skin reactions in the hands and feet 6%, diarrhea 3%, hypertension 4%, thrombocytopenia 1%, and neutropenia 5%. 3, Everolimus (Everolimus, RAD001) foreign multicenter randomized double-blind placebo-controlled phase III clinical study RECORD-1, evaluated the efficacy of everolimus on mRCC, the results showed that the median PFS in the placebo group was 1.9 months, the median PFS in the everolimus treatment group was 4.9 months, and the median PFS in the everolimus treatment group was prolonged significantly. The REACT study was a study to evaluate the efficacy and safety of everolimus in 1,367 patients from 34 countries who failed VEGF/TKI treatment. 4. Axitinib In the AXIS study of second-line treatment of patients with mRCC, axitinib significantly prolonged median disease-free survival PFS in patients with metastatic kidney cancer relative to sorafenib (6.7 months versus 4.7 months, P<0.0001). The most common grade III and IV adverse reactions were hypertension 16%, hand and foot skin reactions 5%, thrombocytopenia 1%, and neutropenia 1%. In foreign treatment guidelines, sotan and doxorubicin are mostly recommended as first-line treatment for advanced kidney cancer, while axitinib and everolimus are recommended as second-line treatment. 2012 US NCCN kidney cancer guidelines recommended sotan as first-line treatment for recurrent or unresectable stage IV kidney cancer (clear cell predominant type), and its evidence level is class L. For specific clear cell Doxorubicin is recommended as first-line treatment with a level of evidence of category 2A; everolimus, axitinib, and doxorubicin are recommended as second-line treatment. For the non-clear cell predominant type, everolimus, doxorubicin, and sotane are recommended as first-line therapy with a level of evidence of category 2A evidence. For experienced doctors in the first line of clinical practice, generally speaking, in addition to the pathological type of the tumor and the efficacy of the drug side effects, it is important to consider the patient's comorbidities and other aspects to achieve efficacy while minimizing the impact of drug side effects on the patient's quality of life. For example, sunitinib should be used with caution in patients with thyroid dysfunction, significantly decreased LVEF, chronic heart disease (chronic heart failure, coronary artery disease, etc.), severe uncontrolled hypertension, etc.; sorafenib causes high incidence of hand-foot skin reactions and gastrointestinal toxic side effects, and is not suitable for patients with chronic gastrointestinal diseases; for those with poor lung function, pneumonia or other active infections, everolimusib should be used with caution. In conclusion, targeted therapy is currently the most effective treatment for advanced kidney cancer; the selection of targeted drugs should take into account the efficacy and side effects of drugs, the risk level of tumor pathology and patient comorbidities in order to achieve individualized treatment and maximize patient benefits. Among them, it should be emphasized that targeted drug therapy is complex, evidence-based and evolving, and for each individual, it should be analyzed on a problem-specific basis.