In RCC, the blockade of PD-1 and CTLA-4 has become the new treatment approach in patients with intermediate- and high-risk metastatic tumors, whereas monotherapy with the PD-1 inhibitor nivolumab is the second-line or third-line treatment approach after failure of VEGF tyrosine kinase inhibitors (16). This evidence concerns the gene CTLA4 and metastatic neoplasm.