Treatment of renal cell carcinoma has dramatically changed in the past 5 years, with the approval of six new drugs since 2006. Although treatment algorithms have been reported and updated every year since 2006, the choice of targeted therapy is not always easy. Selecting a targeted agent in metastatic renal cell carcinoma should take into account various parameters, including the status of the disease, the histology, the status of the patient and finally the availability of the drugs in each country. In addition, in front of every patient, the physician will need to raise important questions such as whether the patient should be treated, should receive surgery and also what is his prognosis. The different options are described here.