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Clinical experience with sunitinib dose escalation in metastatic renal cell carcinoma. The oral multi-targeted tyrosine kinase inhibitor sunitinib malate is a standard first-line therapy in clear-cell metastatic renal cell carcinoma (mRCC). Sunitinib is usually administered daily for 4 weeks, followed by 2 weeks without treatment. Some patients experience worsening of disease symptoms during the treatment break. We report three cases of mRCC in whom continuous daily dosing and dose escalation were evaluated. In two cases, sunitinib was well tolerated at doses of 75 mg continuously and in all cases escalation of dose enabled regain of disease control. This suggests that continuous higher daily dosing of sunitinib is feasible and may provide additional clinical benefit for selected patients who experience minimal toxicity on the standard schedule.