OBJECTIVES: The purpose of the study was to evaluate the relative efficacy of different medication interventions in the treatment of metastatic renal cell carcinoma (mRCC) using a Bayesian mixed treatment comparison (MTC) model. METHODS: A systemic review was undertaken to identify randomized controlled trials assessing the efficacy of bevacizumab, sorafenib, sunitinib, temsirolimus, and everolimus as stand alone therapy or in combination with interferon Alfa.  The search was conducted within seven electronic data bases (CinAhl, AMED, Cochrane Library, Embase, Medline, ASCO, and Clinical trials.gov) for English language publications from inception to June 6th 2009. The Progression Free Survival (PFS) was outcome of interest in this study. Bayesian MTC was performed for evidence synthesis using both fixed and random effect models. With MTC, the relative treatment effect of one intervention compared with another can be obtained in the absence of head-to-head evidence. RESULTS: Sunitinib yielded an effect size of 0.75 (95% credible interval: 0.61-0.93) compared to bevacizumab+interferon; 0.43 (0.31-0.75) compared to bevacizumab; 0.54 (0.37-0.85) compared to sorafenib; 0.74 (0.57- 0.96) compared to temsirolimus; and 0.97 (0.57 – 1.57) compared to everolimus.   CONCLUSIONS: The relative efficacy of sunitinib was better than all medication interventions on PFS except everolimus in the treatment of mRCC.