BACKGROUND Sunitinib and sorafenib are small-molecule tyrosine kinase inhibitors with known antitumor activity in advanced renal cell carcinoma. METHODS We retrospectively assess the response and tolerance of elderly patients with renal cell carcinoma to these two agents. Data of patients aged ≥70years receiving sorafenib or sunitinib at the Centre Léon Bérard were analyzed. Forty-eight patients received sorafenib or sunitinib as a first line treatment, 8 received sorafenib followed by sunitinib and 4 received the reverse sequence. Objective responses (ORs), stable disease (SD), toxicity, overall survival (OS) and progression-free survival (PFS) were reported. RESULTS Sorafenib and sunitinib achieved similar OR+SD rates (79% vs. 71% respectively). Median PFS was 6months in first-line sorafenib treated patients and 5months in the sunitinib group. Median OS was 16months in first-line sorafenib-treated patients and 15months in the sunitinib group. In patients receiving sorafenib followed by sunitinib, median PFS was 11.5months, and median OS was 13.1months. With the reverse sequence, median PFS was 8.1months and median OS was 15months. Treatment modifications were more frequent in sunitinib-treated patients, in first or second line (75% vs. 50%). Limitations are the retrospective design of the study and the small number of patients. CONCLUSIONS First-line sunitinib and sorafenib seem equally efficient in elderly patients treated for advanced renal carcinomas, but sunitinib is less well tolerated. Sequential treatment with sorafenib followed by sunitinib seems to be better tolerated. These results should be confirmed in a larger prospective study.