CTLA4 and nonpapillary renal cell carcinoma: Given the immunogenic nature of ccRCC, immune checkpoint inhibitor (ICI)-based therapies with programmed cell death 1 (PD-1), programmed cell death one ligand 1 (PD-L1) or cytotoxic T lymphocyte antigen 4 (CTLA-4) pathway blockers are increasingly dominant as the current frontline treatment for metastatic disease (4).