In the past 5 years, the introduction of targeted therapy has dramatically changed the outcome of patients with metastatic renal cell cancer (mRCC). In particular, drugs that inhibit signaling of vascular endothelial growth factor (VEGF) and mammalian target of rapamycin (mTOR) have significantly improved the perspectives of patients with this chemoresistant disease. Here, we review the currently approved targeted drugs for the treatment of mRCC. We describe the anti-VEGF monoclonal antibody bevacizumab, the receptor tyrosine kinase inhibitors sunitinib, sorafenib and pazopanib as well as the mTOR inhibitors temsirolimus and everolimus and discuss their role in the contemporary management of patients with mRCC.