DREAMseq (ECOG-ACRIN EA6134)
Settled the order question: for BRAF-mutant melanoma, start with immunotherapy and save the targeted pills for later.
2-year OS 71.8% vs 51.5% for the immunotherapy-first sequence (JCO 2023); the trial was stopped early for benefit. Targeted therapy remained effective after immunotherapy, while immunotherapy after BRAF/MEK failure performed poorly. SECOMBIT reached a similar conclusion.
Setting
Untreated BRAF V600 metastatic melanoma: nivolumab + ipilimumab then dabrafenib + trametinib at progression, vs the reverse sequence
Phase
Phase 3
Sponsor
ECOG-ACRIN / NCI
Registry
Headline result
2-year OS 71.8% vs 51.5%.
Reported
2021
Enrolled
265
Replication
SECOMBIT (phase 2, Italy) independently favoured immunotherapy first.
In plain words
What these results mean for people, not percentages
Overall survival at 2 yearsprimarysurvival endpoint
- 71.8 vs 51.5 out of 100 alive at 2 years with Immunotherapy first compared with Targeted therapy first; 20.3 more per 100.
- Roughly one extra person helped for every 5 treated. That is a rough figure taken from the two percentages, not a guarantee for any one person.
- The p-value (0.010) says a difference this large would rarely happen by chance; it does not say how large or how useful the difference is.
- Overall survival counts deaths from any cause, so it is the most direct measure of whether a treatment helps people live longer.
- These results apply to the people the trial enrolled: Untreated BRAF V600 metastatic melanoma: nivolumab + ipilimumab then dabrafenib + trametinib at progression, vs the reverse sequence. People in a different situation may not see the same effect.
- The trial selected people by a biomarker (BRAF); the result should not be assumed for people whose cancer does not have it.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
265 participants enrolled.
Overall survival at 2 yearsprimary
· p = 0.010
Immunotherapy first71.8 of 100
Targeted therapy first51.5 of 100
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Overall survival at 2 yearsprimary | Immunotherapy first | — | 71.8% | — | 0.010 | link |
| Targeted therapy first | — | 51.5% |
Replication
SECOMBIT (phase 2, Italy) independently favoured immunotherapy first.