CTLA4 and asthenia: The most frequent grade 3 to 4 AEs were asthenia (21 [22.8%]), neutropenia (18 [19.6%]), anemia (8 [8.7%]), and diarrhea (6 [6.5%]) in accordance with grade 3 to 4 AE rates for an irinotecan-based regimen.11,12,15 It is known that combining anti–PD-L1/anti–PD-1 with anti–CTLA-4 increases the proportion of grade 3 to 4 immune-related AEs from 10% to 55%, which is higher than the rate observed in our study of 10.9%.17,22 The fact that we used only 4 courses of anti–CTLA-4 probably lowered the proportion of immune-related AEs.