Starting treatment with combination immunotherapy then giving targeted therapy if the disease progressed led to a significant increase in two-year survival in the DREAMseq phase 3 trial for patients with BRAF V600 mutant metastatic melanoma
Determining the optimal treatment sequence for patients with BRAF V600 mutant metastatic melanoma was the focus of the DREAMseq (EA6134) phase 3 clinical trial, which was stopped early. The combination of nivolumab and ipilimumab, followed by dabrafenib and trametinib if there was disease progression, led to a significant improvement in estimated 2-year overall survival from the start of treatment (72%) when compared to the opposite treatment sequence (52%). The findings were the first presentation at the Inaugural American Society of Clinical Oncology Virtual Plenary Series on November 16.
“We found a 20% increase in two-year survival with a treatment sequence that begins with the combination of nivolumab and ipilimumab immunotherapy followed by targeted therapy using dabrafenib and trametinib in combination if disease progression occurred versus beginning with targeted therapy,” said lead investigator Michael B. Atkins, MD, a medical oncologist and deputy director of the Georgetown Lombardi Comprehensive Cancer Center in Washington, DC.
The dabrafenib and trametinib combination is FDA approved for treating patients with BRAF mutant metastatic melanoma, while the combination of nivolumab and ipilimumab is FDA approved for treating patients with metastatic melanoma regardless of tumor BRAF status.
"Even though the current practice for many physicians is to start treatment with targeted therapy for patients with melanoma that has the BRAF gene mutation, the DREAMseq trial provides strong evidence that immunotherapy is the better initial approach," said Dr. Atkins.
View the abstract at asco.org