Background: Real-world studies with cabozantinib in aRCC have investigated its effectiveness and tolerability in routine practice, but questions remain unanswered including: Activity of systemic therapies after progression on Cabozantinib, patterns of long-responders and use in elderly patients. Methods: OCTOPUS study (NCT05444933) is a retrospective study of all consecutive patients (pts) treated with cabozantinib 2^nd line (2L) for aRCC from March 2018 to March 2021 in 26 French centers. Pre-defined analysis included: descriptive analysis of Cabozantinib 2L regimen, activity of subsequent line (defined by treatment duration), patterns of long-term responders (defined as duration of cabozantinib more than 12 months in patients with complete, partial response or stable disease); and in elderly pts (>75 years). Results: In total, 252 patients were included. Median age was 63 years (20-86), 84.1% had clear-cell histology. At Cabozantinib 2L initiation, among 69 patients with available IMDC score, IMDC risk was favorable/intermediate/poor in 13.0 %, 49.3% and 37.7 % of the cases, respectively. Patients had an ECOG PS of 1 (45.8%) or 2 (25.8%). Bone, liver and brain metastasis (mets), were present in 130 (52.0%), 69 (27.6%) and 34 (13.6%) patients, respectively. 102 (40.5%) pts had 3 or more mets sites and 167 (66.3%) pts had a prior nephrectomy. 154 (61.1%) pts were pretreated with a tyrosine kinase inhibitor (TKi) based regimen and 94 (37.3%) were pretreated with an immunotherapy (IO) based regimen. Results are reported in the table. 157 patients received a 3^rd line (3L) treatment after cabozantinib: nivolumab (55.4%) or a VEGFR TKI (26.1%) including axitinib (85.4%). In this subgroup, the median duration of treatment (DOT) and median progression free survival (PFS) were respectively 8.2 months and 8.0 months, with a disease control rate (DCR) of 80.3 % for Cabozantinib 2L. Conclusions: We reported the pattern of use of Cabozantinib in RWE, highlighting feasibility in elderly and long-term exposure in long responders as well as subsequent therapy activity.