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A study of the pattern of care in metastatic renal-cell carcinoma (mRCC) under circumstances with access to all therapeutic options found that the median survival of patients treated with targeted agents for mRCC was 2.0 years when the initial active surveillance periods are excluded. Exposure to more than 2 lines of systemic drugs did not improve outcome of patients with mRCC.In metastatic renal-cell carcinoma (mRCC), physicians have a plethora of therapeutic choices, with the latest addition of checkpoint inhibitors. However, many questions regarding the best use of the respective drugs remain unanswered. Therefore, it is important to examine and summarize the outcome of real-world experiences to understand the practical value of the various drugs in daily use and foster optimal treatment algorithms for patients with renal-cell carcinoma. We sought to describe the pattern of care in mRCC under circumstances with access to all therapeutic options for patients.We examined the outcome of patients with mRCC who were treated at 8 major centers in Switzerland, mainly with vascular endothelial growth factor–targeted therapy and mammalian target of rapamycin inhibitors. Data from 110 patients with mRCC who had undergone more than one systemic therapy were collected and analyzed. We assessed the pattern of care for patients with mRCC in an unrestricted health care system and outcomes with regard to the respective treatment sequences. We also studied the compliance of individual therapies with published guidelines and correlated the adherence to outcome. Finally, immediate versus deferred treatment and the number of received therapeutic drug lines were analyzed.Median survival of patients treated with targeted agents for mRCC was 2.0 years.Exposure to more than 2 lines of systemic drugs did not improve outcome of patients with mRCC.