CTLA4 and metastatic melanoma: Our results demonstrating that the optimal timing of anti-CTLA4 is before radiation therapy are consistent with anecdotal case reports from patients with metastatic melanoma receiving ipilimumab therapy where systemic responses with long-term disease-free survival occurs have been reported in patients who subsequently receive palliative radiation.[9, 10] Further, a retrospective review of patients receiving ipilumimab who underwent palliative radiation found improved overall survival if radiation was delivered during maintenance versus induction ipilumimab.