Dr Atkins talks to ecancer at ASCO 2025 about longer term data from the phase III DREAMseq trial that evaluated two treatment sequences for patients with untreated BRAFV600-mutant metastatic melanoma (MM):

Immunotherapy with nivolumab/ipilimumab (N/I) followed by targeted therapy with dabrafenib/trametinib (D/T) upon progression, versus the reverse sequence.

With a median follow-up of nearly five years, results confirmed earlier findings that starting with N/I led to significantly better outcomes. The 2-year overall survival (OS) rate was 68.3% for N/I first versus 54.1% for D/T first, with longer median time to CNS progression (12.2 vs 8.4 months), fewer early CNS relapses, and higher rates of durable responses in the N/I-first group.

Although both sequences achieved similar overall response rates (ORR), responses with initial D/T were less durable, with a higher percentage of unconfirmed responses (ucORs) and more frequent early progression, particularly in the central nervous system. Only 24% of responders to D/T remained in response compared to 76% of those treated first with N/I.

At five years, the immunotherapy-first sequence showed nearly a 30% higher OS and threefold improvement in progression-free survival, establishing N/I followed by D/T as the preferred treatment strategy for this patient population.