In the last five years have seen dramatic changes in the treatment of metastatic RCC algorithms, mainly due to the approval of new medicines targeted antiangiogenic therapy and intracellular signaling molecules that inhibit mTOR pathway. All these changes and new therapeutic approaches are reflected in the recommendations of the CSO for routine clinical practice and can be considered a standard treatment for patients with metastatic RCC, which are fully in line with the recommendations of European professional associations.