Although there are increasing numbers of drugs licensed for the treatment of kidney cancer, these can be classified into two groups: the anti-VEGF drugs and the mTOR inhibitors. Dr James Larkin explains how clinicians should assess patient risk level before deciding which drugs should be used in first or second line treatment, discusses level of adverse effects that must be carefully managed and outlines the role immunotherapies could potentially play in the treatment of kidney cancer. Dr Larkin concludes by talking about the early stage results of a clinical trial investigating a novel anti-PD1 drug. These results suggest this agent can produce an encouraging response in melanoma, kidney and lung cancer patients with minimal levels of toxicity.