Immunotherapy for Melanoma Metastatic to the Brain

Most practicing physicians will recall from their training that the average prognosis for patients with central nervous system (CNS) metastases from melanoma was death within a matter of weeks to months.1 This reflected the natural history of a disease on which systemic treatment had a negligible effect. Local therapies, such as surgery and radiotherapy, can palliate symptoms in selected patients, but the outcomes, particularly in patients with multiple metastases treated with whole-brain radiotherapy, are often poor. Moreover, CNS involvement often causes substantial functional impairment, and the use of high-dose glucocorticoids to alleviate edema adds further iatrogenic complications. Patients with CNS . . .