This randomized phase 3 trial of 750 patients with metastatic kidney cancer compared 4 weeks of 50 mg orally daily for 4 weeks (then a 2 week off period) of sunitinib to IFN and found that sunitinib had a significantly better progression free survival rate of 11 v 5 months. Fatigue was more common in IFN group. Diarrhea, vomiting, high blood pressure and hand-foot syndrome were more common in sunitinib group. The median duration of sunitinib treatment was 6 months. For side effects the dose was reduced. Sunitinib is the first line cytokine agent in treatment naïve good risk patients and mainly for clear cell pathology.