Our multicenter retrospective analysis included 499 patients treated with anti-PD-1 agents (nivolumab or pembrolizumab) between 2017 and 2019... In the multivariate analysis, the presence of brain metastases, elevated LDH levels, and the occurrence of at least one irAE had a statistically significant impact on OS and PFS...Anti PD-1 therapy in octogenarian and nonagenarian metastatic melanoma patients has similar efficacy and toxicity compared to patients aged <65 years and 65-79 years.