Dr. Patel on the Sequencing of Immunotherapy and Targeted Therapy in BRAF-Mutant Melanoma
Source: Onc Live, January 2023
Sapna Patel, BA, MD, a medical oncologist, an associate professor, and the director of the Uveal Melanoma Program and Melanoma Fellowship Program at The University of Texas MD Anderson Cancer Center, discusses the sequencing of immunotherapy and targeted therapy in BRAF-mutant melanoma.
Although targeted therapy is a treatment option for patients with unresectable BRAFV600–mutant melanoma, results from the phase 3 DREAMseq trial (NCT02224781) demonstrated that treatment with immunotherapy followed by targeted therapy improved overall survival compared with targeted therapy followed by immunotherapy. Patients enrolled in DREAMseq were randomly assigned to receive the immunotherapy combination of nivolumab (Opdivo) plus ipilimumab (Yervoy) followed by the targeted therapy combination of dabrafenib (Tafinlar) and trametinib (Mekinist), or the converse sequence.
Patients who received the immunotherapy before the targeted therapy experienced a 2-year OS rate of 71.8%, compared with 51.5% for those who received the immunotherapy after the targeted therapy. Although a small number of patients can do poorly with immunotherapy prior to targeted therapy, the trial established this sequence as the standard for this patient population, Patel says