Since 2004, the treatment of metastatic renal cell carcinoma is in deep mutation. Before, the Management was mostly relying on the use of cytokines in association with radical nephrectomy. From 2004, studies of new antiangiogenic molecules, acting on the pVHL-HIF way, VEGF, PDGF or tyrosine-kinase receptors have modified the management of metastatic patients. Antiangiogenic agents improve progression-free survival as shown with sunitinib, in first line treatment, or sorafenib, as second line treatment. The m-TOR inhibitors (Temsirolimus), can be used with a benefit on overall survival in case of poor prognosis renal cell carcinoma or non clear cell carcinoma. Lastly, bevacizumab, an antibody re-combining humanized monoclonal, is able to target VEGF. Side effects are different for each molecule and are not negligible. Nevertheless, the place of these molecules have to be defined in the sequence of the treatment.