There are limited data regarding optimal treatment of metastatic non-clear renal cell carcinoma (nCRCC) from prospective phase II studies comparing tesilomox to sunitinib in patients with non-clear cell renal cell carcinoma. Some data from the ARCC study suggest better progression-free survival (PFS) and overall survival (OS) with tesilomox compared to interferon, and some data from the Sunitinib Expanded Access Project (EAP) have been published to date. Preliminary data from an ncRCC randomized study recently reported by Tannir et al. (ASCO 2014) showed that sunitinib was superior to everolimus in terms of tumor response, PFS, and OS. This article reports data from a small phase II study comparing temsirolimus and sunitinib for the first-line treatment of locally advanced or metastatic ncRCC. Methods and Results A total of 22 patients were enrolled in the study. Patients were randomized 1:1 to receive either temsirolimus 25 mg i.v. 1x/w (TEM group) or sunitinib 50 mg/d orally for 4 weeks and 2 weeks off (SUN group). The primary study endpoint was PFS. overall, 16 patients had papillary renal cell carcinoma, 2 had renal smallpox cell carcinoma, 1 had renal medullary carcinoma, and 3 had unclassified ncRCC. the male to female ratio was 16:6. the median age was 57.4 years in the TEM group and 64.8 years in the SUN group. 59% of patients had an ECOG physical status score of 0 and 41% had ECOG 1. patients in both groups were The two groups were evenly distributed and well matched. The median duration of treatment was 121 days in the TEM group and 141 days in the SUN group. The main reasons for stopping treatment were tumor progression (41.4% vs. 30%), adverse events, or other reasons. The reasons for study closure (8 vs 10 cases) for the cut-off data were: death due to underlying disease (7 vs 5 cases), study closure (1 vs 0 cases), missed visits (0 vs 2 cases) and other reasons (0 vs 2 cases). Preliminary data suggest a trend toward better PFS in the SUN group, but final PFS and OS data will be derived from the final cutoff data. Conclusion Both TEM and SUN are reasonable options for ncRCC. Preliminary data suggest a trend toward longer PFS in the SUN group.