BACKGROUNDT‐regulatory (TR) cells expressing cytotoxic T lymphocyte‐associated antigen‐4 (CTLA‐4) maintain peripheral immune tolerance and negatively affect host immune responses against cancer. The immunobiologic effects of ticilimumab, a human monoclonal antibody against CTLA‐4, was administered to patients with metastatic melanoma who participated in a Phase I/II clinical trial.METHODSThirty patients who received ticilimumab at a dose of 10 mg/kg monthly (n = 20) or 15 mg/kg every 3 months (n = 10) were studied at study entry and at 14‐day intervals thereafter to assess lymphocyte immunophenotypes, interleukin (IL)‐2 and IL‐10 production, and the expression of TR‐related genes in peripheral blood mononuclear cells (PBMC) from a subset of patients was studied by real‐time polymerase chain reaction.RESULTSFour of 12 patients with immune‐related adverse events (IRAE) attained objective antitumor responses (ATR), whereas only 1 of 18 patients without IRAE attained ATR (χ2 = 4.0; P = .0455). Patients with ATR had significant reductions in TR cells and constitutive IL‐10 production accompanied by a significant increase in IL‐2 production by activated T cells. Although IRAE+/ATR+ patients demonstrated a positive correlation between CTLA‐4 and glucocorticoid‐induced tumor necrosis factor receptor (GITR) transcripts (Spearman rho = .522; P = .015), IRAE−/ATR− patients had a positive correlation between the transcripts of CTLA‐4 and program death‐1 (PD‐1) receptor (Spearman rho = .891; P = .000).CONCLUSIONSAntitumor responses in patients with metastatic melanoma who were treated with ticilimumab were found to be correlated with reductions in TR cells and constitutive secretion of IL‐10, an increase in IL‐2 production, and a positive correlation between transcripts of CTLA‐4 and GITR. Conversely, a lack of ATR was found to be correlated with steady levels of TR cells and constitutive IL‐10 secretion, and a positive correlation between the transcripts of CTLA‐4 and PD‐1. Cancer 2006. © 2006 American Cancer Society.