Metastatic renal cell cancer is associated with a poor prognosis and is very resistant to conventional cytotoxic chemotherapy. Progress in the understanding of molecular biology and pathogenesis of renal cell cancer has been translated into the development of new therapeutic strategies. The recent approval of sunitinib, sorafenib, temsirolimus and bevacizumab in combination with IFN-alpha has revolutionized the management of renal cell carcinoma. In this review, we describe the status of current treatment strategies for metastatic renal cell cancer and we focus on the new compounds including targeted therapy such as new anti-angiogenic and mTOR inhibitors.