Immune checkpoint inhibitors (ICIs) combined with VEGFR-TKIs are established first-line treatments for advanced or metastatic renal cell carcinoma (RCC). However, previous meta-analyses often lacked recent published trials or updated follow-up data. Therefore, an updated meta-analysis incorporating recent trials and follow-up data is warranted. A systematic review and meta-analysis of randomized controlled trials comparing ICIs plus VEGFR-TKIs with sunitinib as first-line therapy for advanced or metastatic RCC was performed. Pooled hazard ratios (HRs) and risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using random-effects models. Six phase III trials involving 4,058 patients were identified. Combination therapy significantly improved progression-free survival (HR 0.60, 95% CI 0.51–0.70) and overall survival (HR 0.81, 95% CI 0.73–0.90). The objective response rate analysis showed a significantly lower risk of treatment failure with combination therapy (RR 0.55, 95% CI 0.44–0.68). Regarding safety, grade ≥3 treatment-related adverse events (RR 1.11, 95% CI 1.03–1.20) and treatment discontinuation due to adverse events (RR 2.63, 95% CI 2.02–3.43) were more frequent with combination therapy, whereas fatal events did not differ significantly. Overall, ICIs plus VEGFR-TKIs demonstrated superior efficacy over sunitinib, although associated with an increased risk of adverse events, necessitating proactive management.