Between 15% and 30% of patients with renal cell carcinoma present with metastatic disease by the time of diagnosis and one quarter of patients treated with curative intent suffer from relapse of renal cell carcinoma at distant sites. In the last 25 years, there has been a tremendous evolution of therapeutic concepts starting with the use of cytokines, the introduction of targeted therapies, and most recently the renaissance of immunotherapies. Furthermore, established treatments like cytoreductive nephrectomy lost their status due to new and long-awaited trial results. We will give an overview of the most important past and current therapies and therapy strategies of metastatic renal cell carcinoma including the treatment of metastatic non-clear cell renal cell carcinoma.