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The opt-outs happen asynchronously, so the Webhooks cannot handle them. We do have an alternate method of handling the SMS opt-outs from Twilio. Please get in touch with me - email@example.com for mroe details.
From what I know, Twilio can help Marketo send out messages but feeding data back to Marketo is difficult. It cannot track activities (ie. opens, delivery, etc.), opt outs, etc. Right now, our solution is to go into Twilio and manually drag out the CSV files as exports. I hope this feature is implemented soon!