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FINAL YEAR PHARMACY > CANCER- MELANOMA > Flashcards

CANCER- MELANOMA Flashcards

1
Q

There are two types of non-melanoma skin cancers, what are these?

A

Basal Cell carcinoma

Squamous cell carcinoma

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2
Q

Where is melanoma commonly found in women and men?

A

Men: backs and faces
Women: arms and legs

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3
Q

We use the ABCDEF system to identify melanomas. What does this stand for?

A 
A: Asymmetrical
B: Border
C: colour (colour varies throughout)
D: Diameter  (larger than a pencil eraser)
E: Elevation off the skin
F: Funny mole
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4
Q

What are the risk factors for melanoma?

A

Sun exposure: Exposure to intermittent intense sun is more of a risk than prolonged exposure to UV radiation. Blistering sun burn in childhood a risk!!

Number of Moles

Skin type: Fair haired pale skin more likely

Family history

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5
Q

What does diagnosis of Melanomas involve?

A

patients usaully present with a changing or enlarging or irritating lesion

Mole examined under a dermascope

Excisional biopsy done to remove whole lesions

Histopathology: to determine stage and type of melanoma

Physical examination: lymphadenopathy (see if its spread to lymph nodes)

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6
Q

How do we treat stage 0/1/2/3 melanoma tumours?

A

Excision of the tumour followed by wide local excision to remove a good margin of the healthy tissue

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7
Q

How do we treat stage 4 melanoma tumours?

A

these are advanced tumours and are resectable (i.e. they can’t be cut out)

We treat with chemotherapy

Can use biological therapies: ipilimumab, vemurafenib

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8
Q

What is the prognosis with Advanced/ unresectable melanoma (stage 4)?

A

10 year survival is under 10%

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9
Q

Ipilimumab was the first agent to show an increase in overall survival in advanced/ unresectable malignant melanomas. What is this?

A

A recombinant human monoclonal antibody that will bind to CTLA-4 and block its interaction with its ligands CD80 and CD86.
It is recommended for use after a previous therapy has been tried (e.g. chemotherapy drug Dacarbazine) as its the most expensive cancer drug

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10
Q

Ipilimumab works by blocking CTLA-4. Its mechanism of action is INDIRECT possibly through T cell mediated anti tumour responses. What does this mean?

A

CTLA-4 is a molecule that serves as an immune checkpoint that results in down regulation of T-cell activation. This therefore prevents the immune system attacking cancer cells.

By blocking CTLA-4’s action, Ipilimumab stimulates the anti-tumour T cell response and lots of T cells are produced through unrestrained T cell proliferation

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11
Q

Remember: Ipilumumab blocks CTLA-4’s action which TURNS T CELLS ON

A

It therefore has an indirect action: it doesn’t kill the cell directly but makes the immune system do it!!

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12
Q

What are the side effects of Ipilumumab??

A 
Diarrhoea
Rash
Pruritus
Fatigue
Nausea & vomitting
Decreased appetite
Abdominal pain
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13
Q

Advanced/ unresectable melanoma (stage 4) can be treated using Dacarbazine. what is this?

A

Chemotherapy agent
A DNA alkylating drug
No significant effect on overall survival

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14
Q

What drug can be used in patients that have the BRAF V600 gene mutation?

A

Vemurafenib

Its a BRAF (a tyrosine kinase) inhibitor

Its an oral drug

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15
Q

Vemurafenib is a GOOD drug in Malignant melanoma treatment.

A

Around 90% of patients have tumour regression quickly when treated with this drug!

Overall median survival is 15 months

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16
Q

Vemurafenib is not very well tolerated by patients as it has A lot of side effects.
What are the side effects of Vemurafenib? Try and list 6!!

A 
Fatigue
Joint Pain (patients may need pain killers)
Rash (patients may need emollient, antihistamine or painkillers) 
Sensitivity to the sun 
Nausea
Alopecia
Pruritus (itching)
Headache
17
Q

Vemurafenib causes sensitivity to the sun. What should we advise patients do about this?

A

SPF 30-50 suncream needed in ALL WEATHERS (so even when its cloudy!)
wear long sleeves
Apply a UV resistant film to your windows

Really decreases QoL :(

18
Q

Whats the strange side effect that Vemurafenib can produce?

A

Can actually induce a minor form of skin cancer: Cutaneous squamous cell carcinoma

They can be easily treated by surgical removal but patients should be advised to look out for and new/ changing skin lesions!

19
Q

Vemurafenib is advised by NICE for patients with Malignant Melanomas who have the BRAF V600 mutations.

A

It has many drug interactions as its metabolised by the Cytochrome P450 enzymes

20
Q

Dabrafenib is a BRAF inhibitor like Vemurafenib.

It has similar efficacy to Vemurafenib.
Its advantage is that it is better tolerated.

What are its side effects? (hint: 5 are the same as Vemurafenib, 2 new ones)

A 
Fatigue
Joint pain
Rash
Nausea
Headache

Diarrhoea
FEVER- Patients should report temperatures over 38.

21
Q

Dabrafenib has a slightly unusual side effect like Vemurafenib. What is this?

A

That is can actually cause a minor form of skin cancer: Cutaneous squamous cell carcinoma.
Patients should check for it, but it can be easily treated with surgery

22
Q

Whats the very rare (1%) side effect that can be caused by Dabrafenib?

A

UVEITIS (swelling in the eye)
Can damage vision if its not treated
patients need to report blurry vision, eye redness or irritation

23
Q

What route of administration are Vemurafenib and Dabrafenib?

A

ORAL (tablets

Vemurafenib: taken twice a day WITH food
Dabrafenib: taken twice a day WITHOUT food (empty stomach)

24
Q

How does Pembrolizumab, a new drug, work?

A

It is an anti- PD-1 (programmed cell death receptor inhibitor)
Its a humanised monoclonal antibody
Its given by IV infusion
It blocks the interaction between PD-1 (a programmed cell death receptor) and its ligands: PD-L1 and PD-L2
By doing this: it takes the breaks off the immune system (see notes)

25
Q

When is Pembrolizumab indicated for treatment of skin cancer?

A

For advanced Malignant melanoma following therapy with either ipilimumab or one of the BRAF inhibitors (Vemurafenib or Dabrafenib)

Its doesn’t have a UK license but it available under the UK Early Access to Medicines Scheme!

26
Q

What are the side effects of Pembrolizumab?

A 
Fatigue
Cough
Nausea
Pruritis (itching)
Rash
Decreased appetite
Constipation 
Diarrhoea

FINAL YEAR PHARMACY (18 decks)

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