A phase III trial showed PFS significantly longer with the first-line combination of PD-1 and CTLA-4 nivolumab plus ipilimumab versus chemotherapy among patients with stage IV or recurrent NSCLC that was not previously treated with chemotherapy and a TMB-H (≥10 mutations per megabase) [31]. This evidence concerns the gene CTLA4 and non-small cell lung carcinoma.