Background: Immune checkpoint blockade (ICB) has revolutionized treatment of mismatch repair-deficient (dMMR)/microsatellite instability-high (MSI-H) metastatic colorectal cancer (mCRC). However, there is no evidence on the optimal treatment duration. We aimed to compare outcomes of different immunotherapy durations., Methods: An international multicenter retrospective cohort study of immunotherapy-naïve dMMR/MSI-H mCRC patients who received immunotherapy between 2014-2024. Fixed treatment duration of two years was compared to treatment duration beyond two years. Fixed treatment duration of one year was compared to treatment duration beyond one year. Subgroup analysis was performed for patients who experienced CR. Kaplan-Meier analysis and Cox proportional hazard regression model were used to analyze the effect of all exposure variables on OS., Results: The study cohort included 757 dMMR/MSI-H mCRC patients treated with ICB. Median follow-up time was 46.7 months (IQR 28.5-70.3). There was no statistically significant difference in OS between patients treated for a two-year fixed-duration (n = 83) and those treated beyond two years (n = 139) in both the univariable and multivariable analysis (HR=0.65 95 %CI 0.14-3.07 p = 0.59 and HR=0.61 95 %CI 0.12-3.10 p = 0.6, respectively). The comparison between one-year fixed-duration versus continuing treatment beyond one year included 27 and 330 patients, respectively. For patients who achieved CR, discontinuing treatment after one year was not associated with a negative impact on OS (p = 0.5)., Conclusions: Discontinuing immunotherapy after two years is a reasonable option for dMMR/MSI-H mCRC patients with ongoing response. Treatment discontinuation after one year may be considered for patients achieving CR. Further prospective studies are needed to define the most appropriate duration of therapy., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. SK reported other support from Genentech, EMD Serono, Merck, Holy Stone Healthcare, Novartis, Lilly, Boehringer Ingelheim, AstraZeneca/MedImmune, Bayer Health, Redx Pharma, Ipsen, HalioDx, Lutris, Jacobio, Pfizer, Repare Therapeutics, Inivata, GlaxoSmithKline, Jazz Pharmaceuticals, Iylon, Xilis, Abbvie, Amal Therapeutics, Gilead Sciences, Mirati Therapeutics, Flame Biosciences, Servier, Carina Biotech, Bicara Therapeutics, Endeavor BioMedicines, Numab, Johnson & Johnson/Janssen, Genomic Health, Frontier Medicines, Replimune, Taiho Pharmaceutical, Cardiff Oncology, Ono Pharmaceutical, Bristol Myers Squibb-Medarex, Amgen, Tempus, Foundation Medicine, Harbinger Oncology, Takeda, CureTeq, Zentalis, Black Stone Therapeutics, NeoGenomics Laboratories, Accademia Nazionale Di Medicina, Tachyon Therapeutics, Sanofi, Biocartis, Guardant Health, Array BioPharma, Genentech/Roche, EMD Serono, MedImmune, Amgen, Daiichi Sankyo, and Navire outside the submitted work. TA reported attending advisory board meetings and receiving consulting fees from Abbvie, Astellas, Aptitude Health, Bristol Myers Squibb, Gritstone Oncology, Gilead, GlaxoSmithKline, Merck & Co. Inc., Nordic Oncology, Seagen, Servier, Takeda and honoraria from Bristol Myers Squibb, GlaxoSmithKline, Merck & Co. Inc., Merck Serono, Roche, Sanofi, Seagen and Servier; and a DMC member role for Inspirna and support for meetings from Bristol Myers Squibb, Merck & Co. Inc. and Servier outside the submitted work. MJO reported personal fees from Nouscom, Bayer, Merck, Gritstone, Pfizer, and Janssen outside the submitted work. FP reported receiving institutional research grants from BMS, Incyte, Agenus, Amgen, Lilly and AstraZeneca, and personal fees from BMS, MSD, Amgen, Merck-Serono, Pierre-Fabre, Servier, Bayer, Takeda, Astellas, Johnson&Johnson, Rottapharm, Ipsen, AstraZeneca, GSK, Daiichi-Sankyo, Seagen/Pfizer, Beigene outside the submitted work. No disclosures were reported by the other authors., (Copyright © 2024 Elsevier Ltd. All rights reserved.)