E2 melanoma

Question 1

dendritic pigmented cells that arise from the neural-crest tissue during early fetal development and migrate to sites within the body

Answer 1

melanocytes

Question 2

T or F:
being male is a risk factor for melanomas

Answer 2

yes, for the first time ever

Question 3

70% of cases, lesions arise from a pre-existing nevus over 1 to 5 years

Answer 3

superficial spreading melanoma

Question 4

Clinical presentation acronym:
ABCDE

Answer 4

Asymmetric
have irregular Borders
variety of Colors
Diameter >6mm
Evolution of mole

Question 5

gold standard of diagnostic work up

Answer 5

biopsy of suspected lesion

Question 6

when should the tumor tissue be tested for BRAF V600E and K mutations?

Answer 6

stage IV

Question 7

T or F:
Adjuvant therapy is recommended in melanoma

Answer 7

true, based on stage tho

Question 8

clinical trial or observation:
A. Stage IB or IIA
B. Stage IIB or IIC
C. Stage III

Answer 8

A

Question 9

clinical trial, observation, pembro
A. Stage IB or IIA
B. Stage IIB or IIC
C. Stage III

Answer 9

B

Question 10

Nivolumab, pembro, or dabra/tramet (if BRAF mutant), +/- radiation
A. Stage IB or IIA
B. Stage IIB or IIC
C. Stage III

Answer 10

C. duh bro

Question 11

Unresectable stage III with in-transit lesions

Answer 11

Talimogene Laherparapvec (T-VEC), topical imiquimod, consider radiation, isolated limb perfusion

what the fuck is any of that shit

Question 12

T or F:
In the checkmate trial, toxicities were higher in ipilimumab arm compared to nivolumab

Answer 12

true

Question 13

if you see keynote trial what drug is on your mind (because youre so smart :))

Answer 13

pembro

Question 13

preferred immunotherapy in adjuvant setting

Answer 13

ipilimumab

Question 14

T or F:
Adjuvant dabraf/tramet is used in unresectable stage III disease with BRAF V600E or K mutations

Answer 14

false, completely resected (adjuvant)

Question 15

3 most common toxicities of dabraf/tramet

Answer 15

pyrexia (fever) *
fatigue
nausea

Question 16

first line metastatic treatment options: (3 main choices, many drugs tho)

Answer 16

• anti PD-1 monotherapy (nivolumab, pembro)
• combo targeted tx BRAF mutation (dabraf/tramet)
• certain circumstances (nivolumab/ipilimumab)

Question 17

T or F:
if you fail one PD1 drug you can try a combination and still see effect *

Answer 17

true, she said that was important so lookout for exam question

Question 18

T or F:
chemo is 1st line in metastatic treatment

Answer 18

false, 2nd line

Question 19

what are some of the chemo options in 2nd line metastatic treatment (this is just to familiarize with myself)

Answer 19

dacarbazine
temozolomide
paclitaxel *
albumin bound paclitaxel
carboplatin/paclitaxel

Question 20

Which has a quicker onset of action, targeted therapy or immunotherapy?

Answer 20

targeted (oral)

Question 21

which kind of therapy can take weeks to see effect *

Answer 21

immunotherapy (-mabs)

Question 22

Vemurafenib:
MOA:
Unique toxicities

Answer 22

BRAF kinase inhibitor
Development of squamous cell carcinoma

Question 23

Cobimetinib:
indicated in:
used in combo with:

Answer 23

treatment of unresectable or metastatic melanoma in patients with BRAF mutations
combo with Vemurafenib

Question 24

underlined toxicity for dabraf/tramet *

Answer 24

squamous cell carcinoma (deja vu)

Question 25

why would the combo of encorafenib and binimetinib be preferred over dabraf/tramet? *

Answer 25

less fevers

Question 26

Ipilimumab ____ inhibitor

Answer 26

CTLA-4

Question 27

when to use Nivolumab/Ipilimumab combo

Answer 27

untreated, unresectable stage III or IV

Question 28

Ipilimumab approved in what setting(s)

Answer 28

unresectable and 1st line metastatic

Question 29

weird toxicity with ipilimumab

Answer 29

tumor growth prior to immune system activation

Question 30

Immune related response criteria (irRC):
- Response (before/after) initial increase in disease
- Reduction in total tumor burden after presence of ____ _________
- Very important to understand so therapy isn’t stopped based on what was thought to be progressing disease

Answer 30

after
new lesions

Question 31

how many grades of toxicity are there? What side is worse?

Answer 31

4 on a scale 1-4, 4 is bad

Question 32

which toxicities take the longest to reverse (and may not reverse at all)?

Answer 32

endocrine

Question 33

two most common toxicities of ipilimumab

Answer 33

skin and GI

Question 34

what grades of toxicity do you add a steroid?

Answer 34

3 and 4

Question 35

T or F: chemo rarely cures any patient in the metastatic setting of melanoma

Answer 35

True*

Question 36

2 immunotherapy things underlined on slide 65 but she didnt talk about it much at all

Answer 36

IL-2
Interferon alfa (fallen out of favor)