CTLA4 and neoplasm: Among these is TLR9, whose high expression is associated with improved OS.185 While results of trials evaluating TRL9 agonists (SD-101, CpG) in combination with nivolumab are still pending, the combination of a TRL9 agonist (tilsotolimod) and ipilimumab (anti–CTLA-4) yielded poor responses.116 These TRL9 agonists are delivered via intratumoral injection or electroporation, so physical constraints such as tumor size and density may hinder their effects.