CTLA4 and melanoma: On the other hand, particularly due to the higher rates of immune-related adverse effects observed with the combination treatment, the therapeutic choice between anti-CTLA4/PD1 and anti-PD1 treatments should be grounded on the following prognostic factors: LDH levels, the presence of brain metastases, and comorbidities such as the presence of autoimmune diseases ([28] and the current version of Swiss melanoma guidelines, unpublished).