Sunitinib Malate With or Without Gemcitabine Hydrochloride in Treating Patients With Advanced Kidney Cancer That Cannot Be Removed By Surgery

Inclusion Criteria:

   - Histologically confirmed* renal cell carcinoma of any subtype containing any
   sarcomatoid features NOTE: *Patients must have a paraffin-embedded tumor specimen from
   the kidney or metastatic site available for central review and confirmation of tumor
   histology

   - Measurable advanced disease that is not resectable by surgery

   - Patients with resected or radiated brain metastases or those treated with stereotactic
   radiation therapy are eligible, provided they have been off steroids for at least 2
   weeks

   - More than 2 weeks since prior radiotherapy and recovered

      - Previously irradiated lesions must not be the sole site of disease

   - Eastern Cooperative Oncology Group (ECOG) performance status 0-2

   - Absolute neutrophil count (ANC) ≥ 1,500/mm^3

   - Platelet count ≥ 100,000/mm^3

   - Hemoglobin ≥ 9.0 g/dL (transfusions allowed)

   - Serum creatinine clearance ≥ 30 mL/min

   - serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase
   (SGPT) ≤ 2.5 times upper limit of normal (ULN; ≤ 5 times ULN in the presence of liver
   metastases)

   - Total bilirubin ≤ 1.5 times ULN

   - Baseline corrected QT interval < 500 msec on EKG

   - Able to swallow pills

   - Negative pregnancy test

   - Fertile patients must use effective contraception before and during study treatment

   - More than 2 weeks since prior and no concurrent ketoconazole, dexamethasone,
   dysrhythmic drugs (terfenadine, quinidine, procainamide, sotalol, probucol, bepridil,
   indapamide, or flecainide), haloperidol, risperidone, rifampin, grapefruit, or
   grapefruit juice

   - Patients with a history of prior malignancy are eligible provided they were treated
   with curative intent and have been disease free for the time period considered
   appropriate to not interfere with the outcome of this study

Exclusion Criteria:

   - Collecting duct or medullary carcinoma

   - Prior systemic therapy for metastatic disease. One prior therapeutic regimen with a
   non-tyrosine kinase inhibitor, such as an mtor inhibitor is allowed. Patients who were
   randomized to placebo on an adjuvant study are eligible

   - History of stroke within the past 6 months.

   - Pregnant or nursing

   - Clinically significant cardiovascular disease, defined as one of the following:

      - Uncontrolled hypertension (blood pressure > 150/100 mm Hg at the time of
      enrollment); patients with hypertension and BP ≤ 150/100 mm Hg on stable
      antihypertensive regimen are eligible

      - History of myocardial infarction or unstable angina within the past 24 weeks

      - New York heart association grade II or greater congestive heart failure, serious
      cardiac arrhythmia requiring medication, unstable angina pectoris

      - Peripheral vascular disease ≥ grade II

   - Ongoing ventricular cardiac dysrhythmias ≥ grade 2 as assessed by National Cancer
   Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4

   - History of serious ventricular arrhythmia (ventricular tachycardia or ventricular
   fibrillation > 3 beats in a row)

   - Ongoing atrial fibrillation

   - Pre-existing thyroid abnormality with thyroid-stimulating hormone that cannot be
   maintained at less than or within the normal range with medication

   - Serious concurrent illness or active infection that would jeopardize the ability of
   the patient to receive study treatment

   - Known HIV