OBJECTIVES: To examine the prescribing patterns of the recommended pharmacologic treatments for metastatic renal cell carcinoma (mRCC). METHODS: A retrospective claims-based analysis was conducted that identified incident mRCC patients (18-64 years) in the Thomson Reuters MarketScan Commercial Claims Database (January 2005–September 2008). Patients were required to have at least 6 months of continuous enrollment before the index date (first metastases claim) and at least 30 days of continuous enrollment after the index date. Treatment patterns were described as proportions of mRCC patients receiving the following guideline-recommended pharmacologic agents: immunotherapies (interferon-alpha and interleukin-2) and the newer targeted agents (sunitinib, sorafenib, bevacizumab, temsirolimus and everolimus), either as initial or second-line therapies any time on or after the index date. RESULTS: A total of 1390 patients with mRCC were included in the analysis.  Mean age was 55.6 years and 70.5% were male. The mean continuous enrollment after diagnosis of metastasis was 10.9±8.9 months.  The percentages of patients receiving at least one of these therapies increased from 10.5% in 2005 to 74% in 2008. Sunitinib use showed consistent increase from 0% in 2005 to 50% in 2008. Sorafenib with zero use in 2005 increased to 25% in 2006 but decreased thereafter to 11.7% in 2008. Interferon-alpha  (range: 5-8%) and bevacizumab (range: 2-4%) use remained relatively stable during the observation period, whereas interleukin-2 and temsirolimus was used rarely (≤1%) and everolimus not used at all. CONCLUSIONS: Pharmacologic agents were increasingly used to treat mRCC patients in recent years. Targeted therapies have become the main modality of treatment, with sunitinib accounting for most of the growth.