High levels of ECM biomarkers were associated with poor overall survival and progression-free survival outcomes, with specific markers showing the predictive potential for an improved outcome with monoclonal antibodies nivolumab and ipilimumab, which block programmed death-1 (PD-1) and cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4), compared with sunitinib, a multityrosine kinase inhibitor, in a renal cell carcinoma trial. This evidence concerns the gene CTLA4 and hereditary clear cell renal cell carcinoma.