A multicentre study reviewed 68 patients (mean age 74 years) treated with sunitinib for metastatic renal cell cancer. Fatigue (81%), mucositis (62%) and hypertension (59%) were common. Cardiac events occurred in 9 patients and therapy was stopped early in 10 patients owing to rapidly progressive disease or severe toxicity. Overall, sunitinib was effective, but a lower starting dose escalated in the absence of toxicity should be recommended.