Inclusion Criteria:

1. Histologically or cytologically confirmation of renal cell carcinoma with a clear
cell histologic component

2. Patients must present with stage IV disease not amenable to surgery, radiotherapy, or
combined modality therapy with curative intent.

3. Measurable disease according to RECIST criteria are required but patients with
evaluable lesions without measurable lesions are allowed to be enrolled to this study

4. ECOG performance status 2 or better

5. Age 18 years or older

6. Adequate bone marrow, hepatic, and renal function

7. Life expectancy of > 3 months

8. Singed and dated informed consent of document indicating that the patient (or legally
acceptable representative) has been informed of all pertinent aspects of the trial
prior to enrollment

Exclusion Criteria:

1. Known spinal cord compression or carcinomatous meningitis

2. Diagnosis of any serious secondary malignancy within the last 2 years, except for
adequately treated basal cell or squamous cell carcinoma of skin, or in situ
carcinoma of cervix uteri

3. Hypertension that cannot be controlled by medications (blood pressure > 150/90 mmHg
despite optimal medical therapy)

4. Treatment with anticonvulsant agents and treatment with therapeutic doses of coumadin
currently or within 2 weeks prior to first day of sunitinib administration. Low dose
coumadin for DVT prophylaxis is permitted (up to 2 mg/day).

5. Pregnancy or breast feeding.

6. Other severe acute or chronic medical or psychiatric condition

7. Prior treatment on sunitinib, sorafenib, or bevacizumab.