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Monoclonal antibodies that inhibit the programmed death 1 (PD-1)–programmed death ligand 1 (PD-L1) pathway are clinically active against a broad range of tumors; however, even the most susceptible tumors (e.g., melanoma) respond less than half the time because of innate resistance. In this issue of the
Journal,
Zaretsky et al.
1
describe the use of whole-exome sequencing to identify mechanisms of acquired immune resistance in tumors from patients with melanoma who had a relapse after more than 6 months of tumor response to treatment with pembrolizumab. Tumor regression after PD-1–PD-L1 blockade is presumed to be mediated by the activation of tumor-infiltrating . . .