Assessing Everolimus in Fist Line Treatment on Patients With Metastatic Kidney Cancer

Inclusion Criteria:

1. Metastatic kidney cancer, regardless of histology (except Bellini carcinomas), with measurable or evaluable disease
2. Age \>= 18 years
3. With Karnofsky ≥ 60
4. Without prior treatment for metastatic cancer (chemotherapy, targeted therapy, or mTOR inhibitor)
5. Bad prognosis, defined as follows: at least three of the following six criteria of poor prognosis:

   * Karnofsky \<80
   * LDH\> 1.5 ULN
   * hemoglobin \<LLN
   * corrected calcium\> 2.5 mmol / l (10 mg / dl)
   * Time frame between initial diagnostic and treatment \<1 year
   * More than one metastatic site
6. medullary function: neutrophils ≥ 1.5 x 109 / L, Platelets ≥ 100 x 109 / L, Hb\> 8g/dL
7. Hepatic function: bilirubin: ≤ 1.5 x ULN, ALT and AST ≤ 2.5x ULN in the absence of hepatic metastasis ≤ 5x ULN if hepatic metastasis documented
8. Renal function: creatinine \<1.5 x ULN
9. Life expectancy\> 3 months,
10. Patient signed informed consent and agreeing to comply with the requirements of the trial

Exclusion Criteria:

1. Previous treatment with chemotherapy, targeted therapy, or mTOR inhibitor
2. Previous radiotherapy in the last 2 weeks
3. Chronic treatment with corticoids or immunosuppressive agents except substitutive opotherapy.. A washout period of at least 8 days must be respected before the patient inclusion.
4. Patients with brain metastases untreated or uncontrolled by prior treatment. The non-progression of the metastases must be proved by comparing two brain scans separated by a minimum interval of 6 weeks.
5. Active bleeding
6. Patient with positive serology HBs (Ag HBs (+) and AC anti-HBc (+)
7. Hypersensitivity to everolimus, sirolimus, to other rapamycin derivatives or to any of the excipients
8. Severe or uncontrolled medical pathology:

   * unstable angina, symptomatic heart failure, myocardial infarction ≤ 6 months before randomization, severe rhythm disorder,
   * Uncontrolled diabetes with glycaemia\> 1.5X ULN.
   * Active or uncontrolled infection.
   * cirrhosis or chronic active hepatitis,
   * severe alteration in lung function (\> 50% decrease in FEV or vital capacity)
9. Other cancer within the past 3 years, with the exception of basal cell carcinoma and carcinoma in situ of the cervix
10. Pregnant or lactating woman, and adults refusing an effective contraceptive method
11. Participation in another clinical trial with an investigational drug
12. Refusal of the patient to comply with the rules of the clinical trial
13. Person deprived of liberty or person under guardianship, inability to submit to medical treatment test for geographical, social or psychological reasons.