ICIs, such as anti PD-1/PD-L1 monoclonal antibodies, have shown durable responses in a subset of HCC patients, particularly those with high PD-L1 expression or tumor mutational burden, however, the response rates in HCC are generally low (10-20%), and acquired resistance is common due to compensatory upregulation of alternative immune checkpoints (e.g., CTLA-4, TIM-3) 121, 122. This evidence concerns the gene CTLA4 and hepatocellular carcinoma.