Highlighting the importance of co-stimulatory molecules, recent clinical work has demonstrated that the efficacy of cancer immunotherapies targeting B7 molecules PD-L1 or CTLA-4 in epithelial cancers including non-small cell lung carcinoma as well as colon cancer appear keenly dependent on the gut microbiome; lack of or depletion of commensals using oral antibiotics appears to attenuate tumor response to these therapies (198, 199). This evidence concerns the gene CTLA4 and malignant colon neoplasm.