###Human: Other than Sutent, which medicine can I opt for papillary renal cell carcinoma? ###Assistant: Hello. As per history given above. Your father as metastatic renal cell carcinoma. I would have liked to have few additional markers like his general condition, report of CBC (complete blood count) and LFT (liver function test), RFT (renal function test) to look at his risk score. In metastatic RCC, in first-line settings we have three TKI (Tyrosine kinase inhibitor) that are approved and commonly used. Namely, Sunitinib, Pazopanib, and Cabozantinib. Sunitinib and pazopanib have almost the same progression-free and survival benefit. Cabozantinib has benefit in progression, but final overall survival was the same as sunitinib. Toxicities are bit different for Pazopanib with more chances of hepatitis, weight loss, and diarrhea. If you are not affording for Sunitinib, then I would say Pazopanib would be better as it is cheaper with similar benefits and slightly different toxicities. Cabozantinib is costlier and not yet available. I hope it helps. I would be happy to help you further if you have any more queries or questions regarding toxicities of these drugs. TKI.