Severe thromboembolic phenomenon in the setting of pseudoprogression of melanoma brain metastases in response to combination immunotherapy

Approximately half of patients with metastatic melanoma develop brain metastasis (MBM) in their disease course. However, patients with MBM were often excluded from early immunotherapy trials, and therefore, the role of immunotherapy in these patients is less clear. We review the case of a patient with widespread metastatic melanoma and symptomatic brain metastases at initial diagnosis. In this case, we have demonstrated that it is reasonable to pursue combination ipilimumab and nivolumab in borderline performance status patients with extensive brain metastases. Additionally, this case teaches us to be vigilant for severe autoimmune toxicities such as severe thrombotic events in the setting of pseudoprogression of brain metastases. We discuss this case in the context of the current melanoma literature.

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