For metastatic disease, first-line treatment typically consists of combination therapies with two immune-checkpoint inhibitors (ICIs) including anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) such as ipilimumab and programmed death-1 (PD-1) inhibitors such as nivolumab or an ICI combined with a vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor (TKI) such as cabozantinib [7-9]. This evidence concerns the gene CTLA4 and metastatic neoplasm.