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DREAMseq Sequence — SCE Medical Oncology MCQ

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ModerateMelanoma & SkinDREAMseq SequenceSCE Medical Oncology

A 65-year-old man with advanced melanoma is being counselled about the DREAMseq trial. He has a BRAF V600E-mutant melanoma. What sequence of therapy is optimal?

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Correct answer: A — DREAMseq showed STARTING with immunotherapy (nivolumab + ipilimumab) FIRST, followed by dabrafenib + trametinib at progression, achieved significantly better 2-year OS (72% vs 52%) than the reverse sequence — front-line ICI is preferred unless rapid response is clinically needed

DREAMseq (Atkins et al JCO 2023): randomised BRAF V600 melanoma to ICI-first→targeted vs targeted-first→ICI. ICI-first: 2-year OS 72% vs 52%. This established front-line ICI as preferred for most BRAF-mutant melanoma. Exception: when rapid response is critical (high tumour burden, symptomatic brain mets) — targeted therapy provides faster response.

Reference: DREAMseq Atkins et al JCO 2023; ESMO 2024 Melanoma