This is a male in 60s with a past medical history of renal cell carcinoma with metastasis to the lungs, pleura, intrathoracic lymph nodes and bones. He has been on multiple lines of treatments including pazopanib, axitinib, cabozantinib, then transitioned to everolimus and nivolumab. However, cancer continued to progress which lead to termination of this regimen. Three weeks after his last (fourth) dose of nivolumab, he started developing severe epigastric pain, nausea and vomiting, prompting a visit to the ER where patient was ultimately diagnosed with a stomach perforation secondary to checkpoint inhibitors. Patient was treated with supportive measures given advanced stage of malignancy, ultimately expiring on the same admission.