Schvartsman G, Ma J, Bassett RL, et al. - Researchers sought to determine the incidence, patterns of disease progression, and outcomes of melanoma brain metastases (MBM) in patients treated with anti–PD-1 immunotherapy. They reviewed 320 patients (median age: 63.3 years) with melanoma (MM) who received anti–PD-1 at The University of Texas MD Anderson Cancer Center in Houston. Among patients without prior MBM, MBM developed in 21 patients (8.6%) during anti–PD-1 therapy, 12 of whom (4.9%) presented with disease progression in the central nervous system (CNS) only. They observed shorter overall survival in correlation with the development of MBM during or after therapy with anti–PD-1. Analysis suggests a possible change in the natural history of patients with preexisting MBM on receiving anti–PD-1 therapy. However, a worse prognosis was evident with CNS failure during treatment with anti–PD-1 compared with extracranial progression. Results thereby support the activity of anti–PD-1 in patients with MBM, however, routine CNS imaging during therapy is recommended.