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Although symptomatic MBM patients were historically excluded from immunotherapy trials, efforts from clinicians and patient advocates have resulted in more inclusive and even dedicated clinical trials for MBM patients. The results of checkpoint inhibitor trials were discussed in conversation with current standards of care for MBM patients, including steroids, radiotherapy, and targeted therapy. Advances in the basic scientific understanding of MBM, including the role of astrocytes and metabolic adaptations to the brain microenvironment, are exposing new vulnerabilities which could be exploited for therapeutic purposes. Technical advances including single\u2010cell omics and multiplex imaging are expanding our understanding of the MBM ecosystem and its response to therapy. This unprecedented level of spatial and temporal resolution is expected to dramatically advance the field in the coming years and render novel treatment approaches that might improve MBM patient outcomes.<\/jats:p>","DOI":"10.1111\/pcmr.13059","type":"journal-article","created":{"date-parts":[[2022,8,1]],"date-time":"2022-08-01T08:24:46Z","timestamp":1659342286000},"page":"554-572","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Melanoma central nervous system metastases: An update to approaches, challenges, and opportunities"],"prefix":"10.1111","volume":"35","author":[{"given":"Alcida","family":"Karz","sequence":"first","affiliation":[{"name":"Department of Pathology NYU Grossman School of Medicine  New York USA"},{"name":"Interdisciplinary Melanoma Cooperative Group Perlmutter Cancer Center, NYU Langone Health  New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya","family":"Dimitrova","sequence":"additional","affiliation":[{"name":"Interdisciplinary Melanoma Cooperative Group Perlmutter Cancer Center, NYU Langone Health  New York USA"},{"name":"Department of Medicine NYU Grossman School of Medicine  New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Kleffman","sequence":"additional","affiliation":[{"name":"Department of Pathology NYU Grossman School of Medicine  New York USA"},{"name":"Interdisciplinary Melanoma Cooperative Group Perlmutter Cancer Center, NYU Langone Health  New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Alvarez\u2010Breckenridge","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael B.","family":"Atkins","sequence":"additional","affiliation":[{"name":"Georgetown\u2010Lombardi Comprehensive Cancer Center and Department of Oncology Georgetown University Medical Center  Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrienne","family":"Boire","sequence":"additional","affiliation":[{"name":"Human Oncology and Pathogenesis Program, Department of Neurology Memorial Sloan Kettering Cancer Center  New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Bosenberg","sequence":"additional","affiliation":[{"name":"Laboratory of Cancer Biology and Genetics Center for Cancer Research NCI, NIH  USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priscilla","family":"Brastianos","sequence":"additional","affiliation":[{"name":"MGH Cancer Center, Department of Medicine Massachusetts General Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel P.","family":"Cahill","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Massachusetts General Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Chen","sequence":"additional","affiliation":[{"name":"Immunology, Microenvironment and Metastasis Program The Wistar Institute  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6344-0615","authenticated-orcid":false,"given":"Sherise","family":"Ferguson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3756-8594","authenticated-orcid":false,"given":"Peter","family":"Forsyth","sequence":"additional","affiliation":[{"name":"Department of Neuro\u2010Oncology and Tumor Biology H. 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