Background: Multiple targeted agents are available to treat metastatic renal cell carcinoma (mRCC) and no consensus has been reached for optimal treatment sequencing. This study describes physician-reported treatment preferences, reasons for treatment choices, and current treatment patterns for mRCC in the community setting. Methods: A physician survey and retrospective chart review was conducted during May and June 2012 among community-based oncologists or hematologists who had ≥5 mRCC patients under their care in 2011. Charts were reviewed for adult mRCC patients initiated on 2^nd-targeted therapy after January 2010 to collect information on current treatment sequence in mRCC patients and reasons for treatment choices. A parallel survey collected physician treatment preferences for 1^st-, 2^nd-, and 3^rd-targeted therapies for mRCC patients with good or poor prognosis. Results: The study included surveys from 36 physicians and charts from 433 mRCC patients. The majority of patients (77%) received a tyrosine kinase inhibitor (TKI) and the rest (23%) received a mammalian target of rapamycin inhibitor (mTOR) as the 1^st-targeted therapy. Sunitinib was the most common TKI and temsirolimus was the most common mTOR in the 1^st-line setting. Among patients receiving 1^st-line TKI, 34% received TKI (pazopanib was most used TKI) and 66% received mTOR (everolimus was most used mTOR) in the 2^nd-line. Among 1^st-line mTOR users, 94% used TKI (sunitinib was most used) and 6% mTOR (everolimus was most used) for 2^nd-line. TKI-mTOR-TKI was the most commonly observed treatment sequence. Physician-stated preferences for 1^st and 2^nd targeted therapies were largely consistent with the results from the chart review, though actual mTOR use in the 2^nd-line was greater than expected. Treatment guidelines and evidence from clinical trials were the top-ranked factors impacting treatment choices. Conclusions: In this large, retrospective chart review, TKI-mTOR-TKI was the most commonly observed treatment sequence for mRCC in the community setting.