In many treatment choices in medicine, there are a dearth of randomized data to inform treatment decision. However, in the first-line treatment of metastatic renal cell carcinoma, there are a myriad of trials. However, nearly all have been designed as two-armed studies comparing a novel treatment approach to the current standard of care, beginning with placebo and moving to interferon and subsequently sunitinib. Thus, there is no direct comparative data for most of the agents currently available today.