DREAMSeq Trial Clarifies Treatment Sequencing in BRAF V600–Mutant Melanoma
Source: Onc Live, November 2022
Immunotherapy followed by targeted therapy has emerged as the new standard of care for patients with melanoma with BRAF V600 mutations, according to Andrew L. Pecora, MD, FACP, CPE, who explained that patients tend to live longer when receiving ipilimumab (Yervoy) plus nivolumab (Opdizvo) before receiving dabrafenib (Tafinlar) plus trametinib (Mekinist).
The phase 3 DREAMseq trial (NCT02224781) investigated the anti–PD-1/CLTA-4 immunotherapy combination of ipilimumab plus nivolumab followed by the anti–BRAF/MEK targeted therapy combination of dabrafenib plus trametinib vs the reverse sequence in patients with advanced BRAF V600–mutant melanoma. Patients who received the immunotherapy before the targeted therapy experienced a 2-year overall survival (OS) rate of 71.8% (95% CI, 62.5%-79.1%) vs 51.5% (95% CI, 41.7%-60.4%; log-rank P = .010) in those who received the immunotherapy after the targeted therapy.
“The immunotherapy combination of a PD-1 inhibitor and a CTLA-4 inhibitor was far superior when given first followed by targeted therapy, if needed, than the alternative, which is starting with targeted therapy and switching to immunotherapy," Pecora said in an interview with OncLive®.