OBJECTIVES: This study assessed real-world overall survival (OS), time on treatment (TOT), and dose intensity among aRCC patients who initiated pazopanib or sunitinib, two commonly-used first targeted therapies (TT). METHODS: Patients aged ≥65 with aRCC who initiated pazopanib or sunitinib as first TT (index date) were identified from the 100% Medicare data + Part D linkage (1/1/2006-12/31/2014). Patients were stratified by first TT and matched 1:1 using propensity scores based on age, sex, race, year of RCC diagnosis, metastatic sites, and baseline comorbidities and costs (assessed 1 year before index date). OS was defined as the time from index date to death from any cause; TOT as the time from index date to the earliest of treatment discontinuation (a prescription gap of >90 days) or death from any cause. For both outcomes, patients were censored at the earliest of end of eligibility or data cut-off. Dose intensity was defined as the ratio of days that the patient had received drug supply to TOT. OS and TOT were compared between matched cohorts using Kaplan-Meier analyses and univariable Cox models; dose intensity was compared using Wilcoxon signed-rank tests. RESULTS: Before matching, the pazopanib cohort (N=526) was associated with higher outpatient visits and costs and lower pharmacy costs than the sunitinib cohort (N=1,185; all p<0.05). After matching, all baseline characteristics were balanced (N=522 for both). First TT with pazopanib was associated with significantly longer OS (median: 18.2 vs. 14.6 months, p<0.05; hazard ratio [HR]=0.83, 95% confidence interval [CI]: 0.72-0.97), similar TOT (median: 4.8 vs. 4.1 months, p=0.16; HR=0.90, 95% CI: 0.78-1.04), and lower dose intensity (mean: 0.91 vs. 0.94, p<0.01) compared with the sunitinib cohort. CONCLUSIONS: Among Medicare patients with aRCC, first TT with pazopanib compared to sunitinib was associated with significantly longer OS, similar TOT, and lower dose intensity.