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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.
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.
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.
Shares Dabrafenib, Trametinib, BRAF V600-mutant melanoma.
Shares Dabrafenib, Trametinib, BRAF V600-mutant melanoma.
Shares DREAMseq (ECOG-ACRIN EA6134), Ipilimumab, Nivolumab.
Shares Dabrafenib, Trametinib, Journal of Clinical Oncology.
Shares Dabrafenib, Trametinib, Journal of Clinical Oncology.
Shares Trametinib, BRAF V600-mutant melanoma, Advanced melanoma (unresectable stage III and stage IV).
Shares Ipilimumab, Journal of Clinical Oncology, Nivolumab.
Shares Dabrafenib, Trametinib.