In Reply to Yilmaz et al

To the Editor: We thank Yilmaz et al for their insights and questions concerning our recent publication (1, 2). The combination of radiation therapy and immune checkpoint inhibition (ICI) is hypothesized to augment the immune system's anti-tumor response; however, the optimal timing and sequencing of therapy remains a subject of continued investigation (3). While ICI alone without central nervous system (CNS)-directed radiation has previously been reported to provide some therapeutic efficacy in patients with brain metastases, the kinetics with which ICI administration results in immunomodulation in the CNS requires further evaluation (4-6).

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