Metastatic castration-resistant prostate cancer (mCRPC) is immunologically``cold"and predominantly resistant to immune checkpoint therapy due to few tumor-infiltrating T cells . Ipilimumab (anti-CTLA-4) or anti-PD-1/PD-L1 monotherapy failed to show a significant benefit . Although the PD-1/PD-L1 pathway is minimally expressed in prostate tumors, we previously demonstrated that PD-1/PD-L1 expression increases as a compensatory inhibitory pathway in parallel with an ipilimumab-induced increase in tumor-infiltrating T cells . Here, we report the largest trial to date in mCRPC with anti-CTLA-4 plus anti-PD-1 (nivolumab 1 mg/kg plus ipilimumab 3 mg/kg; CheckMate 650, NCT02985957). With median follow-ups of 11.9 and 13.5 months in cohorts 1 (pre-chemotherapy; n = 45) and 2 (post-chemotherapy; n = 45), objective response rate was 25% and 10%, and median overall survival was 19.0 and 15.2 months, respectively . Four patients, two in each cohort, had complete responses . Exploratory studies identify potential biomarkers of response . Grade 3-4 treatment-related adverse events have occurred in â¼42% -53% of patients, with four treatment-related deaths . Therefore, dose/schedule modifications have been implemented.