We here explore the soluble Human Leukocyte Antigen-G (sHLA-G) expression level as clinical biomarker in metastatic colorectal cancer (mcRc). to this aim the sHLA-G protein was measured in plasma samples of 40 patients with mCRC treated with the FOLFIRI (irinotecan (CPT-11) plus 5-fluorouracil (5-FU) and leucovorin (LV)) regimen. The results suggest a link between HLA-G levels and irinotecan (CPT-11) pharmacokinetic, leading to hypothesize a molecular interaction between sHLA-G and CPT-11. This interaction was confirmed experimentally by fluorescence spectroscopy. HLA-G is known to exist in a number of polymorphs that affect both the protein expression levels and its peptide-binding cleft. The interaction between HLA-G polymorphs and CPT-11 was explored by means of computational modelling, confirming the hypothesis that CPT-11 could actually target the peptide binding cleft of the most common HLA-G polymorphs. The possibility to measure and monitor the level of soluble Human Leukocyte Antigen-G (sHLA-G) in body fluids such as plasma, serum, ascites, cerebrospinal fluids exudates, and the identification of early variations in HLA-G levels is emerging as a precious tool for the early diagnosis of cancer diseases and to monitor the appearance of recurrences 1. Although tissue and/or soluble HLA-G were already observed upregulated in patients with several cancers compared to healthy donors 2-6 , further investigation about its therapeutic role is still needed. HLA-G exerts immunoinhibitory activities mainly through a direct interaction with ILT receptors on effector cells and an indirect mechanism through regulatory cells 7. A specific inhibitory interaction of HLA-G expressed by target cells against TILs, in particular CD8+ ILT2+ T cell cytotoxicity, was reported as a mechanism of tumor escape from immunosurveillance 8. Recently, Pagès and colleagues showed the relevance of a new method called Immunoscore to stratify patients evaluating the presence of CD3+ and CD8+ T-cell effectors (TILs) and ensuring a more precise treatment with a better prognostic value in colon cancer 9. However, not all the independent evaluators are concordant for the TIL evaluation on hematoxylin and eosin stained and the concordant analysis was performed only on 10% of whole cohort (n = 268 cases) 9. The clinical relevance of sHLA-G expression has recently suggested that a stratification based on sHLA-G levels could also be an independent predictive and prognostic factor for patients with colorectal cancer (CRC) because its presence could alter the TILs interaction and then the immune system response 10. Moreover, these patients are often administered with irinotecan (CPT-11) as part of their therapy. CPT-11 is an antineoplastic drug present in several regimens used in combination with other chemotherapeutics to treat metastatic CRC (mCRC). It is also investigated for clinical applications in gastric, lung, pancreas, cervix, and ovarian cancers 11-16. CPT-11 acts as antineoplastic enzyme inhibitor of the DNA topoisomerase I, interfering wit...