In vulvar TDLN, beside PD-1 upregulation, in particular high expression levels on T helper cells of CTLA-4 were noticeable upon tumor invasion, which, together with high Treg frequencies and decreased rates of effector T cells, suggested that combined CTLA-4 and PD-1 blockade might help block metastatic spread of this tumor type [113]. This evidence concerns the gene CTLA4 and neoplasm.