Dr Ascierto on First-Line Treatment Selection in Advanced BRAF+ Melanoma

Paolo A. Ascierto, MD, director, Unit of Melanoma, Cancer Immunotherapy and Innovative Therapy, National Tumor Institute Fondazione G. Pascale, discusses treatment sequencing considerations for patients with advanced BRAF-mutant melanoma, based on findings from the phase 2 SECOMBIT (NCT02631447) and phase 3 DREAMseq (NCT02224781) trials.

Ascierto notes that each of these trials demonstrated improved overall survival when initiating treatment with immune checkpoint inhibitor–based therapy rather than targeted therapy in the first-line setting for this patient population, suggesting that resistance to targeted agents may compromise subsequent immunotherapy efficacy. Additionally, SECOMBIT evaluated a sequential "sandwich" approach, incorporating a short course of targeted therapy before transitioning to immunotherapy, which may benefit select patients with high tumor burden or elevated lactate dehydrogenase levels, Ascierto explains. These findings contribute to ongoing discussions on optimizing first-line treatment strategies in BRAF-mutant melanoma.