And the 2023 Paper of the Year distinction by the Journal of Clinical Oncology goes to … a team of melanoma researchers with the ECOG-ACRIN Cancer Research Group (ECOG-ACRIN).
The recognition is for the results of the DREAMseq randomized phase 3 clinical trial. DREAMseq (EA6134) showed an optimal treatment sequence for combination therapy in patients with advanced melanoma with a BRAFV600 tumor gene mutation. The treatment sequence beginning with immunotherapy (nivolumab and ipilimumab), followed by targeted therapy (dabrafenib and trametinib) if there was disease progression, resulted in a 20% absolute improvement in 2-year overall survival (72% v 52%) compared with the sequence beginning with dabrafenib and trametinib.
“When the results of the DREAMseq trial emerged, they had an immediate impact on clinical practice because these are U.S Food and Drug Administration-approved regimens,” says lead researcher Michael B. Atkins, MD, a medical oncologist at Georgetown University Lombardy Comprehensive Cancer Center and a member of the ECOG-ACRIN Melanoma Committee, in a news release.
Journal editors selected Dr. Atkins and the ECOG-ACRIN-led DREAMseq team based on the overall impact and reach of trial results among all papers during the year.
“After years of research, many exciting and effective new combination treatments exist for patients with advanced melanoma,” says Dr. Atkins. “Further, the use of one treatment can affect a patient’s response to another treatment. Consequently, patients and their physicians often find themselves with multiple treatment options but few answers to questions surrounding how and when to use these approved approaches.”
JCO Associate Editor Gary K. Schwartz, MD, writes: “The optimal sequence of targeted molecular therapy versus checkpoint inhibitor immunotherapy as first-line treatment for patients with BRAFV600-mutant metastatic melanoma has represented a major therapeutic challenge. This study addresses this issue and settles this question by showing that immunotherapy should precede targeted therapy as the first-line treatment for patients with BRAFV600 metastatic disease.”
More discoveries will emerge from DREAMseq, as Dr. Atkins and colleagues are now validating biomarker findings from biopsy tissue and blood samples contributed by trial participants.
Dr. Atkins states that “the goals of these biomarker studies are to identify at a molecular level the subset of patients who benefit from starting with targeted therapy and those who don’t appear to benefit from either treatment approach and thus would be candidates for alternative therapies.”
ECOG-ACRIN designed and conducted the DREAMseq trial, spearheading an extensive collaboration across multiple cancer centers, community hospitals, and sister cooperative groups in the U.S. These include the Alliance for Clinical Trials in Oncology, NRG Oncology, and SWOG Cancer Research Network. The National Cancer Institute, part of the National Institutes of Health, funded the endeavor through its National Clinical Trials Network.
