CTLA4 and neoplasm: Thus, detection of multiple cytokines at elevated expression levels in response to NY-ESO-1 antigen stimulation suggests that patients with advanced disease (in our cohort, 92% had stage IIIC melanoma) have an NY-ESO-1 specific immune response, though this is likely functionally dampened in the tumor microenvironment by immune checkpoints such as PD-1/PD-L1 [25] and CTLA-4 [26].