Until recently, little prospective data existed to guide the choice of initial therapy or sequence in patients with BRAF V600 mutant metastatic melanoma. The randomized phase III trial DREAMseq (EA6134) showed that starting treatment with immunotherapy (nivolumab and ipilimumab), followed by targeted therapy (dabrafenib and trametinib) if there was disease progression, led to a clinically meaningful 20% improvement in estimated 2-year overall survival from the start of treatment when compared to the opposite treatment sequence (72% vs. 52%, respectively).

The DREAMseq results were considered practice-changing upon their original presentation at the Inaugural ASCO Plenary Series (November 2021). Michael B. Atkins, MD (Georgetown-Lombardy Comprehensive Cancer Center), presented an update at the 2022 Annual Meeting of the American Society of Clinical Oncology.