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In BRAF-mutant melanoma, start with immunotherapy and keep the targeted pills in reserve; the reverse order costs lives.
This sequence rule for BRAF-mutant melanoma is to start with immune checkpoint inhibitors, nivolumab with ipilimumab, and to keep the BRAF/MEK inhibitors dabrafenib and trametinib, or encorafenib-based therapy, in reserve. Immunotherapy responses are durable and can be curative, whereas BRAF/MEK responses are fast but nearly always temporary, so using the durable option first preserves the fast option as a rescue. The phase 3 DREAMseq trial showed a clear overall survival advantage for immunotherapy first, and the phase 2 SECOMBIT trial was concordant. Targeted therapy still works after immunotherapy, but immunotherapy after targeted therapy underperforms, possibly because progression on BRAF/MEK inhibitors is rapid and the tumours are immunologically cold.
Shares Dabrafenib + trametinib, Encorafenib, BRAF, Melanoma.
Shares Ipilimumab, Nivolumab, Melanoma, Immune checkpoint inhibitors.
Shares Ipilimumab, Nivolumab, Melanoma, Immune checkpoint inhibitors.
Shares Encorafenib, BRAF, Ipilimumab, Nivolumab.
Shares Ipilimumab, Nivolumab, Melanoma, Immune checkpoint inhibitors.
Shares BRAF, Ipilimumab, Nivolumab, Melanoma.
Shares Ipilimumab, Nivolumab, Immune checkpoint inhibitors.
Shares Ipilimumab, Nivolumab, Immune checkpoint inhibitors.