Anti-angiogenic agents have modified therapeutic strategies in the management of metastatic renal cell carcinoma. Regarding molecules that already available such as sunitinib, sorafenib, temsirolimus and bevacizumab, clinical trials are now focused on the improvement of their effectiveness, overall survival, response's criteria and toxicity. In the light of recent data, these treatments will be tested in adjuvant situation to radical nephrectomy, but also as an alternative option to radical surgery. The place of radical nephrectomy in metastatic renal cell carcinoma has been recently strongly discussed. I n the future, the systematic radical surgery will not be a rule any more. From now on, renal cell carcinoma patients have to be included in numerous ongoing therapeutic trials to manage anti-angiogenic agents in the best manner.