In what scenario would you consider dual IO and TKI therapy in advanced stage melanoma?

Triplet therapy with the combination of vemurafenib, cobimetinib, and atezolizumab provides a new treatment option for patients with advanced BRAF-mutated melanoma. However, given the lack of survival benefit thus far and increased toxicity, I currently do not routinely employ this as frontline therapy for my patients. Additionally, based on the results of DREAMseq trial, I prefer using a combination of ipilimumab plus nivolumab frontline then switching to BRAF/MEKi therapy upon progression. That being said, there may be subsets of patients who may stand to benefit from this approach. In the COMBI-i and KEYNOTE-022 trials, a trend favoring the triplet combination was seen in patients with poor prognostic features such as high LDH, more than...