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VISTA is highly expressed on tumor infiltrating myeloid cells including myeloid derived suppressive cells MDSC , which have been associated with resistance to immunotherapy. Similarly, warfarin-treated mice had higher rates of tumor cure following radiation that was also abrogated by CD8 depletion. Providers should counsel patients on the unique mechanism of action and side effect profile of ICIs both prior to initiation and throughout the course of treatment using a communication style that is best suited to each individual patient. The phase II SWOG S study randomized 92 patients with advanced melanoma with primary resistance to anti-PD-1 therapy to receive ipilimumab plus nivolumab followed by nivolumab maintenance versus ipilimumab monotherapy. The oncology team should provide support and education for the optimal management of long-term, fixed immune-related toxicities eg, hypoadrenalism, hypothyroidism, diabetes.

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