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Severe thromboembolic phenomenon in the setting of pseudoprogression of melanoma brain metastases in response to combination immunotherapy
  1. Matthew C Perez1,
  2. Hsiang-Hsuan M Yu2,
  3. Joseph Markowitz1
  1. 1Department of Cutaneous Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
  2. 2Department of Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
  1. Correspondence to Dr Joseph Markowitz, joseph.markowitz{at}


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.

  • skin cancer
  • cancer intervention
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  • Contributors MCP: writing of original manuscript. HMY: writing of original manuscript with radiation oncology perspective, review and editing. JM: writing of original manuscript, review and editing, supervision.

  • Funding JM receives support from the Donald A Adam Comprehensive Melanoma Research Center at Moffitt Cancer Center and is an Assistant Professor in the USF Morsani College of Medicine Department of Oncologic Sciences. JM was supported in part by the National Cancer Institute (NCI), part of the National Institutes of Health, under grants number P50 CA168536, Moffitt Skin Cancer SPORE.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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