Renal cell cancer is a relatively unusual tumour. It accounts for less than 1% of deaths from malignant disease and is diagnosed in about 2500 people each year in the United Kingdom and 200 000 people worldwide.1 2 Our understanding of the molecular biology of renal cell cancer has recently undergone many changes. These changes have informed the development of drugs, and new treatments have become available. The most recent of these, the multitargeting kinase inhibitors, have improved the outlook of patients with renal cell cancer to such an extent that older treatments are becoming obsolete. However, despite evidence of their effectiveness their availability in the UK has lagged behind that in the United States because of the time taken to obtain regulatory approval. So what is the evidence of the effectiveness of these treatments?

The clue to the molecular changes involved in renal cell cancer come from the Von Hippel Lindau syndrome, in which a mutation in a …