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To provide an overview and summary of the recent developments in the use of targeted therapy in the management of advanced kidney cancer. The focus is on publications within the last year.The last year has seen several exciting developments in the targeted approach to managing advanced renal cell carcinoma. The benefits of small-molecule tyrosine kinase inhibitors have been demonstrated in two large-scale, phase III prospective, randomized controlled trials. There is growing evidence, some not yet published, that mammalian target of rapamycin inhibitors are effective in this disease and the roles of therapies directed at the receptor for vascular endothelial growth factor continue to be refined.Recent published trials offer substantial hope for those patients with advanced kidney cancer, where before the outlook was often bleak. There is an expanding menu of potential agents in this disease, so-called targeted therapies, that are grounded in a growing understanding of the biology of kidney cancer. Many challenges and questions still remain, but there are encouraging signs of progress and hope for the future.