Ipi/Nivo Discontinuation Higher in Older vs Younger Patients with mRCC

At the 2026 ASCO GU Symposium, Antonio Ocejo, MD, a hematology/oncology fellow at Memorial Sloan Kettering Cancer Center presented on a multi-institutional analysis involving 514 patients, focusing on the clinical outcomes and tolerability of the combination therapy of ipilimumab (Yervoy) and nivolumab (Opdivo) in patients with metastatic clear cell renal cell carcinoma (mRCC). The study specifically compared a younger cohort to an older cohort, defined as individuals aged 70 years or older, to determine if age impacts the efficacy or safety of the dual immunotherapy regimen.

Tolerability and Treatment Discontinuation

Ocejo noted significant disparities in how the 2 age groups tolerated the induction phase of treatment. The analysis revealed that older patients were significantly less likely to complete the full 4-dose induction of the combined agents. The primary driver for this discrepancy was treatment-related toxicity. Older patients exhibited higher rates of treatment discontinuation due to immune-related adverse events (irAEs). In contrast, younger patients were more likely to cease treatment due to disease progression than drug intolerance. The increased rate of adverse-event-driven discontinuation in the elderly population was found to be statistically significant compared to their younger counterparts.

Comparable Clinical Outcomes

Despite the challenges in tolerability and the lower rate of induction completion among older patients, the clinical outcomes remained surprisingly consistent across both groups. There was no significant difference in overall survival between the younger and older cohorts. Even with different reasons for stopping therapy, the total time on treatment was comparable between the 2 populations.

Future Research Directions

While the current data confirms that the total sum of immune-related adverse events occurs more frequently in older patients, Ocejo indicated that the research team is currently conducting a more granular toxicity analysis. This forthcoming data aims to identify if specific types of irAEs are more prevalent in older populations. These detailed findings will be included in the final manuscript to provide a comprehensive profile of how age influences the safety of dual checkpoint inhibition.