# DREAMseq (ECOG-ACRIN EA6134): sequencing dabrafenib-trametinib and nivolumab-ipilimumab in BRAF-mutant metastatic melanoma

Source: https://onco.cc/key-papers/paper-dreamseq-jco-2023/  
OnCo record `paper-dreamseq-jco-2023` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Starting with nivolumab plus ipilimumab and switching to BRAF-MEK inhibitors at progression gave 20 percentage points better two-year survival than the reverse order in BRAF-mutant advanced melanoma, settling the question of which to use first.

## Summary

Phase 3 trial of 265 patients with treatment-naive BRAF V600-mutant metastatic melanoma randomised to nivolumab-ipilimumab followed by dabrafenib-trametinib at progression, or the reverse sequence.

Two-year overall survival was 71.8 percent with immunotherapy first against 51.5 percent with targeted therapy first; the trial was stopped early for this difference, and responses to immunotherapy were more durable while responses to targeted therapy after immunotherapy were preserved.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: Journal of Clinical Oncology
- Year: 2023
- DOI: 10.1200/JCO.22.01763
- Authors: Atkins MB, Lee SJ, Chmielowski B, et al.
- Findings: Two-year overall survival 71.8 percent (immunotherapy first) vs 51.5 percent (targeted therapy first).; Median progression-free survival after crossover favoured targeted therapy given second.
- What it means: Immunotherapy first is the standard for BRAF-mutant advanced melanoma in patients who can wait for a response; targeted therapy is reserved for rapid control or after immunotherapy.
- Caveats: Open-label and stopped early.; Does not address newer first-line options such as nivolumab-relatlimab.

## Sources

- J Clin Oncol 2023: https://doi.org/10.1200/JCO.22.01763
- PubMed: https://pubmed.ncbi.nlm.nih.gov/36166727/

## Connected records

- cancers: [Advanced melanoma (unresectable stage III and stage IV)](https://onco.cc/cancers/advanced-melanoma/), [BRAF V600-mutant melanoma](https://onco.cc/cancers/braf-v600-melanoma/)
- drugs: [Dabrafenib](https://onco.cc/drugs/dabrafenib/), [Ipilimumab](https://onco.cc/drugs/ipilimumab/), [Nivolumab](https://onco.cc/drugs/nivolumab/), [Trametinib](https://onco.cc/drugs/trametinib/)
- trials: [DREAMseq (ECOG-ACRIN EA6134)](https://onco.cc/trials/dreamseq/)
- journals: [Journal of Clinical Oncology](https://onco.cc/journals/jco/)

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