title: CTLA-4 blockade with ipilimumab induces significant clinical benefit in a female with melanoma metastases to the CNS.
abstract: BACKGROUND
  A 63-year-old female presented to her primary physician with numbness and weakness in her left leg, which progressed over several days to involve her entire lower extremities. MRI of the spine and brain revealed multiple metastases. The patient received ipilimumab and after 3 months experienced intermittent confusion and focal seizures.
  
  
  METHODS
  Electroencephalogram and MRI scans of the spine and brain, followed by surgical removal of a left frontal cortical brain metastasis and subsequent histological and pathological analyses.
  
  
  METHODS
  Metastatic melanoma from an unknown primary tumor.
  
  
  RESULTS
  The patient was treated with ipilimumab on a compassionate-use program and dexamethasone, celecoxib, and levetiracetam to treat the symptoms and seizures. Postoperative stereotactic radiosurgery was initiated.
authors.affiliation: Melanoma Program, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA. stephen_hodi@dfci.harvard.edu
authors.forename: F Stephen
authors.initials: FS
authors.lastname: Hodi
authors.forename: Darryl A
authors.initials: DA
authors.lastname: Oble
authors.forename: Jan
authors.initials: J
authors.lastname: Drappatz
authors.forename: Elsa F
authors.initials: EF
authors.lastname: Velazquez
authors.forename: Nikhil
authors.initials: N
authors.lastname: Ramaiya
authors.forename: Naren
authors.initials: N
authors.lastname: Ramakrishna
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Day
authors.forename: Andrea
authors.initials: A
authors.lastname: Kruse
authors.forename: Suzanne
authors.initials: S
authors.lastname: Mac Rae
authors.forename: Axel
authors.initials: A
authors.lastname: Hoos
authors.forename: Martin
authors.initials: M
authors.lastname: Mihm
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D015703:Antigens, CD / Q000378:metabolism*; D001932:Brain Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D060908:CTLA-4 Antigen; D002490:Central Nervous System / Q000000981:diagnostic imaging / Q000473:pathology; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000074324:Ipilimumab; D008545:Melanoma / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000473:pathology; D011859:Radiography; D016634:Radiosurgery; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D015703:Antigens, CD; D060908:CTLA-4 Antigen; C556706:CTLA4 protein, human; D007166:Immunosuppressive Agents; D000074324:Ipilimumab