For a patient with metastatic melanoma with small, asymptomatic brain mets what is your preferred systemic therapy?

I lean towards ipi 3 mg/kg and nivo 1 mg/kg per the clinical trials, with very close interval follow-up with brain MRI at around 6 weeks to assess for response. Certainly not unreasonable to radiate then do Nivo/Rela as well. I tend to radiate before Nivo/Rela since the brain met data is less robust...

In this scenario, I default to using a combination of ipilimumab plus nivolumab. We know from prior clinical trials that have looked at this combination of patients with asymptomatic brain metastases that immunotherapy seems to work similarly well intracranially as it does extracranially. This was e...