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. According to foreign studies, about 30% of patients had distant metastasis at the time of diagnosis, and 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 molecularly 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 in the near future. Patients in China should have an understanding of the side effects of the above 4 drugs and the basic principles of targeted drug therapy, and work with your primary care physician to choose the right targeted drug for you to achieve the best treatment effect. Zhang Jinyi, Department of Urology, Shanghai Renji Hospital Efficacy and side effects of commonly used drugs1 Sotan (sunitini, Sutent) A multinational multicenter phase III randomized clinical trial confirmed the efficacy of sotan instead of a interferon as first-line treatment for advanced kidney cancer. The 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), ORR was significantly higher (47% vs. 12%; P<0.000001), and OS was 26.4 months and 21.8 months, respectively (P=0.001). (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-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 renal cancer multi The central, randomized, controlled phase III clinical study (TARGET) showed that sorafenib significantly prolonged median progression free survival (PFS) (5.5 months versus 2.8 months, P<0.01) and significantly prolonged overall survival (17.5 months versus 2.8 months, P<0.01) in patients with metastatic kidney cancer compared with placebo. 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 The foreign multicenter randomized double-blind placebo-controlled phase III clinical study RECORD-1, which evaluated the efficacy of everolimus in mRCC, showed that The REACT study, an evaluation of the efficacy and safety of everolimus in 1,367 patients from 34 countries who had failed VEGF/TKI therapy, showed that there was no significant increase in the toxic effects of everolimus, but the efficacy remained maintained, with the most common grade III and IV adverse reactions being anemia 4%, stomatitis 5%, hyperglycemia 15% and pneumonia 4%.4 Axitinib (Axitinib) significantly prolonged median disease-free progression survival PFS in patients with metastatic kidney cancer relative to sorafenib in the AXIS study of second-line treatment of patients with mRCC (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 level of evidence 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, doximetil, 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 a high incidence of hand-foot skin reactions and gastrointestinal toxic side effects, and is not suitable for patients with chronic gastrointestinal disease; everolimusibe should be used with caution in patients with poor lung function, pneumonia or other active infections. 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 the drugs, the risk level of tumor pathology and patient comorbidities, etc., in order to achieve individualized treatment and maximize the benefits for patients. Among them, it is important to emphasize that targeted drug therapy is complex, evidence-based and evolving, and for each individual, specific analysis is needed.