{"entity":{"id":"paper-dreamseq-jco-2023","kind":"paper","name":"DREAMseq (ECOG-ACRIN EA6134): sequencing dabrafenib-trametinib and nivolumab-ipilimumab in BRAF-mutant metastatic melanoma","aka":[],"tldr":"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.\n\nTwo-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.","asOf":"2026-09-17","links":[{"label":"J Clin Oncol 2023","url":"https://doi.org/10.1200/JCO.22.01763"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/36166727/"}],"tags":[],"related":[],"cancers":["advanced-melanoma","braf-v600-melanoma"],"sections":[],"technologies":[],"targets":[],"drugs":["dabrafenib","ipilimumab","nivolumab","trametinib"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["dreamseq"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["jco"],"dependsOn":[],"notes":[],"journal":"Journal of Clinical Oncology","year":2023,"doi":"10.1200/JCO.22.01763","pmid":"36166727","authors":"Atkins MB, Lee SJ, Chmielowski B, et al.","paperType":"rct","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."],"whatItMeans":"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."],"changedPractice":true,"participants":265},"route":"/key-papers/paper-dreamseq-jco-2023/","neighbours":{"cancer":[{"id":"advanced-melanoma","kind":"cancer","name":"Advanced melanoma (unresectable stage III and stage IV)","route":"/cancers/advanced-melanoma/"},{"id":"braf-v600-melanoma","kind":"cancer","name":"BRAF V600-mutant melanoma","route":"/cancers/braf-v600-melanoma/"}],"drug":[{"id":"dabrafenib","kind":"drug","name":"Dabrafenib","route":"/drugs/dabrafenib/"},{"id":"ipilimumab","kind":"drug","name":"Ipilimumab","route":"/drugs/ipilimumab/"},{"id":"nivolumab","kind":"drug","name":"Nivolumab","route":"/drugs/nivolumab/"},{"id":"trametinib","kind":"drug","name":"Trametinib","route":"/drugs/trametinib/"}],"trial":[{"id":"dreamseq","kind":"trial","name":"DREAMseq (ECOG-ACRIN EA6134)","route":"/trials/dreamseq/"}],"journal":[{"id":"jco","kind":"journal","name":"Journal of Clinical Oncology","route":"/journals/jco/"}]}}