OBJECTIVES:  Renal cell carcinoma (RCC) is responsible for 13,500 deaths annually in the United States alone. Although historically difficult to treat for patients with advanced disease, a number of promising therapies are on the horizon. The objective of this study was to document the current treatment patterns for patients with metastatic RCC and how they vary regionally. METHODS:  A retrospective chart review of RCC patients was conducted by physicians in the United States (N=9,481), 5EU (France, Germany, Italy, Spain, UK; N=5,840), and Japan (N=695) between Q2 2015 and Q1 2016. Physicians randomly selected patient charts currently on an anti-cancer regimen and abstracted data on patient demographics, disease status, and treatment patterns. Treatments patterns were reported descriptively and compared across countries using chi-square tests. RESULTS:  A total of 16,016 patients were included. The mean age was 64.8 years (SD=10.7) with 64.6% of patients being male. Nearly two-thirds (65.4%) of patients had an ECOG score of 1. Sunitinib was the most common first-line (1L) therapy across all regions (US: 73.8% to Japan: 32.4%). Pazopanib was the second-most common 1L therapy in 5EU (23.0%) but less used in Japan (11.2%) the US (6.0%). Both interferon alpha (16.0%) and axitinib (15.8%) were disproportionately more common in Japan (p<.05). Axitinib (2L across regions: 15-50%; 3L across regions: 7-36%) and everolimus (2L across regions: 14-40%; 3L across regions: 40-62%) were the most common later-line treatments regardless of country. CONCLUSIONS:  Sunitinib is an important part of 1L therapy across countries, though regional variation exists. Regional consistency was more common in later lines in which axitinib and everolimus had similar usage patterns. Given the upcoming availability of additional therapy options, this study provides an important baseline assessment of current treatment patterns in the US, Western Europe, and Japan.