Immunotherapy before targeted therapy significantly improves advanced melanoma survival

A clinical trial led by clinicians at Georgetown Lombardi Comprehensive Cancer Center showed a remarkable 20 percent advantage in the two-year overall survival rate for people with advanced melanoma who first received immunotherapy versus those who initially got targeted therapies. Progression-free survival, where the cancer is stable or improving, was also trending in favor of those who started on immunotherapy.

The multicenter, phase III trial, DREAMseq, was led by oncology professor Michael Atkins. The DREAMseq trial found that for patients with melanoma that have a mutation in the BRAF gene, specifically a BRAF V600 mutation, immunotherapy is the better initialn approach than giving drugs that specifical target this mutated pathway.

Starting in 2015, 265 trial participants with metastatic melanoma were randomly assigned to two groups: one group received a targeted drug combination (dabrafenib and trametinib) followed by an immunotherapy combination (ipilimumab and nivolumab) if their cancer resisted the first combination and the other group received the immunotherapy combination first and the targeted therapy if necessary. The trial was stopped early due to the clear evidence of the benefit of giving immunotherapy first.

According to the National Cancer Institute, there will be an estimated 99,780 new cases diagnosed and 7,650 deaths due to melanoma in 2022. A steep drop in melanoma deaths from 2015 to 2019 of about 4% per year is largely attributable to advances in treatment.

Reference:

Michael Atkins. et al,Combination dabrafenib and trametinib versus combination nivolumab and ipilimumab for patients with advanced BRAF-mutant melanoma: The DREAMseq Trial - ECOG- ACRIN EA6134,Journal of Clinical Oncology