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case_images: Development of an asymptomatic brain metastasis in patient case 1. Computed tomography brain scans of patient case 1 prior to initiating treatment with avelumab (A) on August 16, 2017, and (B) on October 2, 2017.
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case_images: At this time, the patient also developed 1 asymptomatic brain metastasis (largest diameter, 18 mm on October 2, 2017;  Figure 1 ).
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case_images: Complete response of 2 asymptomatic brain metastases in patient case 3. Magnetic resonance imaging scans of patient case 3: (A) with 2 brain metastases in the left occipital lobe and right temporal lobe prior to starting avelumab (May 9, 2018); (B) Complete response in occipital lobe and partial response in temporal lobe metastases after 8 months of avelumab (January 21, 2019); (C) PD in temporal lobe metastasis after 10 months of avelumab (April 29, 2019; patient began concurrent SRS on May 31, 2019); (D) substantial decrease in size of temporal lobe metastasis after SRS and 15 months of avelumab (September 4, 2019); (E) Complete response in both metastases (June 16, 2020; avelumab treatment stopped on February 24, 2020).
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case_images: In April 2018, a PET scan showed PD by RECIST 1.1 in the left supraclavicular (30-mm node) and axilla regions, and a brain magnetic resonance imaging (MRI) scan on May 9, 2018, showed the presence of 2 asymptomatic brain metastases in the right medial temporal lobe adjacent to the optic chiasm (29 mmx25 mm) and left occipital lobe (33 mmx31 mm;  Figure 2A ). October 17, 2018, showed a complete response by RECIST 1.1 of the occipital metastasis and a partial response by RECIST 1.1 of the temporal lobe metastasis (reduced to 21 mm). On January 21, 2019, an MRI scan showed a substantial decrease in the size of the temporal lobe metastasis to 5 mmx3 mm; the left occipital lobe metastasis was cystic with no enhancement ( Table 2 ;  Figure 2B ). On April 29, 2019, a brain MRI scan showed that the anterior medial part of the right temporal lobe metastasis was larger (maximum transverse dimension of 21 mm) and surrounded by increased white matter edema ( Figure 2C ). On September 4, 2019, an MRI scan showed the right temporal metastasis had reduced in size (maximum transverse dimension of 8 mm;  Figure 2D ). MRI scans on June 16 ( Figure 2E ) and October 28, 2020 showed volume loss and no enhancement of the brain metastases.
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