Five-year clinical trial results presented at the annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago confirmed the efficacy of immunotherapy as first-line treatment for patients with BRAF mutant melanoma.

This study is called “Dream Seq,” and readers might recall that the initial results were revealed at ASCO 2021 and updates are presented each year. Final, five-year results were presented earlier this week.

Trial participants were treated with either the combination of dabrafenib (Tafinlar) and trametinib (Mekinist) first (n=132) or ipilimumab (Yervoy) and nivolumab (Opdivo) first (n=135). When the patients had disease progression after therapy, they were switched to the alternative combination they had not yet received, either dabrafenib/trametinib or ipilimumab/nivolumab.

After two years of treatment, 88.8% of patients who received immunotherapy first were free from brain and central nervous system or CNS metastasis.

For the majority of patients with BRAF mutant melanoma, ipilimumab/nivolumab immunotherapy should be the initial treatment they receive, followed by the combination of BRAF and MEK inhibitors (dabrafenib/trametinib) as second line treatment, according to the results.

After two years of treatment, 88.8% of patients who received immunotherapy first were free from brain and central nervous system or CNS metastasis. Only 62.1% of the patients who received BRAF/MEK inhibitors first were free of CNS metastasis. After four years, 76.0% of patients who received immunotherapy first were free from CNS metastasis, and 62.1% of patients who received BRAF/MEK inhibitors were also free from CNS metastasis.

The benefits of using immunotherapy first were also observed in a longer duration of sustained therapeutic benefit. After five years, the patients who started with immunotherapy had a better average overall survival, with 76.4% of patients still responding to treatment. In comparison, 23.9% of patients who began with BRAF/MEK inhibitors were still responding.

The results are practice-changing and establish immunotherapy as the preferred initial treatment for patients with BRAF mutant melanoma. They were presented during an oral talk by Michael Atkins titled, “DREAMseq (ECOG-ACRIN EA6134): a Phase III Trial of Treatment Sequences in Patients with BRAFV600-mutant (m) Metastatic Melanoma (MM): Final Clinical Results,” on June 3, 2025.