Methylation of DNA at CpG sites is the most common and stable of epigenetic changes in cancer. Hypermethylation acts to limit immune checkpoint blockade immunotherapy by inhibiting endogenous interferon responses needed for recognition of cancer cells. By contrast, global hypomethylation results in the expression of programmed death ligand 1 (PD-L1) and inhibitory cytokines, accompanied by epithelial-mesenchymal changes that can contribute to immunosuppression. The drivers of these contrasting methylation states are not well understood. DNA methylation also plays a key role in cytotoxic T cell 'exhaustion' associated with tumor progression. We present an updated exploratory analysis of how DNA methylation may define patient subgroups and can be targeted to develop tailored treatment combinations to help improve patient outcomes. DNA Methylation, ICB, and Cancer DNA methylation can have major effects on gene expression and is the most commonly studied type of epigenetic modification (see Glossary). It comprises the covalent modification of the nucleotide cytosine at the 5ʹ position at sites preceding guanine (CpG) [1]. During mammalian cell division, it is replicated by the maintenance enzyme DNA methyltransferase 1 (DNMT1) on the daughter strand cytosine at the complementary CpG, usually resulting in gene silencing. New sites of DNA methylation, known as de novo methylation, can be introduced by DNMT3a or DNMT3b (Box 1). Conversely, methyl groups can be erased by ten-eleven translocation (TET) family proteins followed by glycosylation and replacement with an unmethylated cytosine. DNMT1 recruitment to replicating chromatin is facilitated by the 'ubiquitin-like with PHD and ring-finger domains' (UHRF) E3 ubiquitin ligase UHRF1 [2,3]. Methylation at CpG sites can also be recognized by methyl CpG binding 'reader' proteins such as methyl-CpG binding domain protein 1 (MBD1) and methyl-CpG binding protein 2 (MeCP2) harboring transcriptionally repressive activity. The latter may bind histone deacetylases (HDACs), which can contribute to the repression of certain genes [4]. Highlights Genome-wide DNA methylation is a relatively stable epigenetic characteristic of cells, which can be dysregulated in cancer cells by oncogenic signals.