BACKGROUND: Ipilimumab and nivolumab (ipi/nivo) improved overall survival (OS) compared to sunitinib in the pivotal Checkmate 214 trial of metastatic renal cell carcinoma (mRCC) with International Metastatic RCC Database Consortium (IMDC) intermediate/poor risk disease. We evaluated the efficacy and toxicity of ipi/nivo in older and frailer populations in a real-world mRCC cohort. METHODS: Analysis was conducted on a real-world cohort with mRCC (N = 551) treated with first-line ipi/nivo from the Canadian Kidney Cancer information system (CKCis) database from January 2014 to December 2021. A comparison was made between outcomes and toxicity in patients 1. <
70 versus (vs.) ≥70 yo, 2. <
75 vs. ≥75 yo, and 3. KPS ≥70 vs. <
70 yo. OS, progression-free survival (PFS), and time to treatment failure (TTF) were calculated by Kaplan-Meier analysis. Log-rank tests were used for comparison between groups. RESULTS: Ipi/nivo treatment had no impact on survival outcomes or toxicity for patients >
70 yo and >
75 yo when controlled for IMDC. However, when comparing patients with KPS >
70 vs. KPS <
70, patients with a poor performance status had decreased median OS at 54.5 m vs. 10.8 m ( CONCLUSIONS: The use of ipi/nivo in mRCC demonstrated similar survival outcomes and toxicity in an older patient population. In patients with a poor performance status, it was associated with inferior OS and PFS. We believe that ipi/nivo is a reasonable treatment option for these patient populations, particularly in older patients.