In CA209-538, TMB did not show a meaningful predictive value in cancer patients treated with nivolumab and ipilimumab, whereas high blood TMB was associated with favorable clinical benefit with durvalumab (anti-PD-L1) and tremelimumab (anti-CTLA-4) versus chemotherapy in MYSTIC clinical trial [9, 10]. This evidence concerns the gene CTLA4 and cancer.