Kluger HM, et al. - Researchers assessed long-term survival of pembrolizumab-treated patients with new or progressing brain metastases treated on a phase II clinical trial. Using the modified Response Evaluation Criteria in Solid Tumors (RECIST), brain metastasis response (the primary end point) to 24 months pembrolizumab treatment was evaluated in 23 patients with melanoma with one or more asymptomatic, untreated 5- to 20-mm brain metastasis not requiring corticosteroids; 70% of patients had prior systemic therapy. A brain metastasis response was seen in 6 patients (26%). The median progression-free survival of 2 months and median overall survival of 17 months was reported. With acceptable toxicity and durable responses, pembrolizumab showed activity in melanoma brain metastases. For the optimal management of patients with brain metastases, there is a need for multidisciplinary care, including consideration of radiation to large or symptomatic lesions, which were excluded in this trial. Compared with patients without brain metastasis treated with anti–programmed cell death 1 agents, a similar 2-year survival was observed. Concordant brain and extracerebral responses were seen, suggesting that pembrolizumab can be used to treat small, asymptomatic brain metastases.