Objective: The efficacy of pazopanib and sunitinib are comparable in favorable-to intermediate-risk metastatic renal cell carcinoma (mRCC) patients. However, whether pazopanib or sunitinib have different outcomes in poor-risk patients is unknown. This study aimed to investigate the efficacy of these drugs in a real-world poor-risk patient population. Material and Methods: The medical records of 46 mRCC patients treated with sunitinib or pazopanib between 2012 and 2018 in the outpatient clinic in the Department of Medical Oncology, Faculty of Medicine, Eskisehir Osmangazi University were retrospectively evaluated. Risk classification was done based on the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) system. Results: The objective response rate (ORR) was significantly higher in patients treated with pazopanib than in those treated with sunitinib (50% vs. 16.7%; p=0.038). The median progression-free survival (PFS) was six months in the sunitinib group and 9.9 months in the pazopanib group, among poor-risk patients only (p=0.36). However, the median PFS was almost equal between the sunitinib and pazopanib group, among favorable- to intermediate-risk patients (12.4 months vs. 13.9 months; p=0.97). Anemia, elevated liver function tests, hand and foot syndrome, and hyponatremia were higher in patients treated with pazopanib. However, neutropenia and leucopenia were more frequent in patients treated with sunitinib. Conclusion: Pazopanib might be an appropriate first-line therapy in poor-risk mRCC due to improved PFS rates and ORRs compared to sunitinib. However, extensive, multi-center, prospective studies are required to support these results.