Combination Sunitinib and Gemcitabine in Sarcomatoid and/or Poor-risk Patients With Metastatic Renal Cell Carcinoma

Inclusion Criteria: * Histologically proven metastatic renal cell carcinoma with any sarcomatoid histology or poor-risk features as defined by having 3 or more of the following characteristics: * PS \> 1, high serum lactate dehydrogenase * low hemoglobin * high "corrected" serum calcium * 2 or more sites of metastatic disease * time from initial diagnosis to evidence of metastatic disease 12 months or less * Evidence of unidimensional measurable disease based on RECIST criteria, with at least 1 measurable lesion * Male or female, 18 years of age or older * ECOG performance status of 0-2 * Patients with brain metastasis can only be included of they were treated 4 weeks or more prior to enrollment with whole brain radiation and the effects of treatment have resolved * Resolution of all acute toxic effects of prior therapy, radiotherapy or surgical procedure to NCI CTCAE version 3.0 grade of 1 or less * Laboratory values as outlined in the protocol * 2 weeks or more must have elapsed from the time of major surgery or radiation therapy prior to the day of registration * No anticipated need for major surgical procedure during the course of the study Exclusion Criteria: * Prior treatment with sunitinib or gemcitabine * More than one prior systemic therapy of any kind for renal cell carcinoma * Uncontrolled high blood pressure * Any prior history of hypertensive crisis or hypertensive encephalopathy * Any of the following within the 6 months prior to study drug administration: myocardial infarction, severe/unstable angina, coronary/peripheral artery bypass graft, cerebrovascular accident or transient ischemic attack, or symptomatic congestive heart failure * Ejection fraction \< 30% * Pre-existing thyroid abnormality with thyroid function that cannot be maintained in the normal range with medication * NCT CTCAE grade 3 or higher hemorrhage within 4 weeks of starting treatment * Significant vascular disease * Current grade 3 or higher cardiac dysrhythmia or QT prolongation * Concurrent use of proarrhythmic medications including terfenadine, quinidine, procainamide, disopyramide, sotalol, probucol, bepridil, haloperidol, risperidone, indapamide, and flecainide * Pregnancy or breastfeeding or inadequate contraception * Evidence of bleeding diathesis or coagulopathy * Serious, non-healing wound, ulcer or bone fracture * Psychiatric illness/social situation that would limit compliance with study requirements * Previous diagnosis of concurrent malignancy requiring active systemic therapy