Dr. Pavlick on Sequencing Immunotherapy Vs Targeted Therapy in BRAF-Mutated Melanoma

Anna C. Pavlick, DO, professor of Medicine, the Division of Hematology and Medical Oncology, Weill Cornell Medicine, founding director, the Cutaneous Oncology Program, Weill Cornell Medicine and New York-Presbyterian, discusses the sequencing of immunotherapy vs targeted therapy in BRAF-mutated melanoma.

The phase 3 DREAMseq trial (NCT02224781) evaluated initial treatment with ipilimumab (Yervoy) plus nivolumab (Opdvio) followed by dabrafenib (Tafinlar) plus trametinib (Mekinist) after disease progression, vs the converse sequence of combinations, in patients with stage III to IV melanoma harboring a BRAF V600 mutation.

DREAMseq addressed the controversy of how to sequence targeted therapy vs immunotherapy in patients with BRAF-mutated melanoma, Pavlick says. The large, randomized trial randomly assigned patients to begin treatment with the immunotherapy combination of ipilimumab and nivolumab or targeted therapy with dabrafenib plus trametinib, Pavlick explains. Patients crossed over to the other combination at the time of progression, Pavlick adds.

Two-year data from of the trial showed that patients given immunotherapy prior to targeted therapy experienced a greater benefit, Pavlick concludes.