Session Item

There is an increasing evidence that, in the era of effective immunotherapy with checkpoints inhibitors or targeted agents against driver mutations in melanoma and NSCLC, radiotherapy, either stereotactic radiosurgery or whole-brain radiation therapy, can be delayed at salvage to minimize the risk of cognitive deficits in long-surviving patients. In this regard some points seem to be clear. Immunotherapy with either ipilimumab alone or ipilimumab combined with nivolumab is indicated as initial treatment in patients with brain metastases from melanoma who are not BRAF mutant and do not need steroids. Immunotherapy with pembrolizumab is indicated as initial treatment in patients with small and asymptomatic brain metastases from NSCLC without druggable molecular alterations and with PDL1 expression. Patients with small and asymptomatic brain metastases from EGFR-mutant and ALK-rearranged NSCLC or BRAF-mutant melanoma should receive targeted agents as initial therapy.