VEGFA and metastatic neoplasm: Historically, systemic therapy for metastatic disease has been disappointing with limited efficacy when employing immunomodulatory therapy (Interleukin-2 and Interferon-alpha).[2, 3] In the past decade, however, several kinase-directed therapies targeting vascular endothelial growth factor (VEGF) and mammalian target of rapamycin (mTOR) have been approved for CC-RCC while several novel kinase-targeted agents are in various stages of preclinical and clinical development for this disease.