E2 melanoma Flashcards
dendritic pigmented cells that arise from the neural-crest tissue during early fetal development and migrate to sites within the body
melanocytes
T or F:
being male is a risk factor for melanomas
yes, for the first time ever
70% of cases, lesions arise from a pre-existing nevus over 1 to 5 years
superficial spreading melanoma
Clinical presentation acronym:
ABCDE
Asymmetric
have irregular Borders
variety of Colors
Diameter >6mm
Evolution of mole
gold standard of diagnostic work up
biopsy of suspected lesion
when should the tumor tissue be tested for BRAF V600E and K mutations?
stage IV
T or F:
Adjuvant therapy is recommended in melanoma
true, based on stage tho
clinical trial or observation:
A. Stage IB or IIA
B. Stage IIB or IIC
C. Stage III
A
clinical trial, observation, pembro
A. Stage IB or IIA
B. Stage IIB or IIC
C. Stage III
B
Nivolumab, pembro, or dabra/tramet (if BRAF mutant), +/- radiation
A. Stage IB or IIA
B. Stage IIB or IIC
C. Stage III
C. duh bro
Unresectable stage III with in-transit lesions
Talimogene Laherparapvec (T-VEC), topical imiquimod, consider radiation, isolated limb perfusion
what the fuck is any of that shit
T or F:
In the checkmate trial, toxicities were higher in ipilimumab arm compared to nivolumab
true
if you see keynote trial what drug is on your mind (because youre so smart :))
pembro
preferred immunotherapy in adjuvant setting
ipilimumab
T or F:
Adjuvant dabraf/tramet is used in unresectable stage III disease with BRAF V600E or K mutations
false, completely resected (adjuvant)
3 most common toxicities of dabraf/tramet
pyrexia (fever) *
fatigue
nausea
first line metastatic treatment options: (3 main choices, many drugs tho)
- anti PD-1 monotherapy (nivolumab, pembro)
- combo targeted tx BRAF mutation (dabraf/tramet)
- certain circumstances (nivolumab/ipilimumab)
T or F:
if you fail one PD1 drug you can try a combination and still see effect *
true, she said that was important so lookout for exam question
T or F:
chemo is 1st line in metastatic treatment
false, 2nd line
what are some of the chemo options in 2nd line metastatic treatment (this is just to familiarize with myself)
dacarbazine
temozolomide
paclitaxel *
albumin bound paclitaxel
carboplatin/paclitaxel
Which has a quicker onset of action, targeted therapy or immunotherapy?
targeted (oral)
which kind of therapy can take weeks to see effect *
immunotherapy (-mabs)
Vemurafenib:
MOA:
Unique toxicities
BRAF kinase inhibitor
Development of squamous cell carcinoma
Cobimetinib:
indicated in:
used in combo with:
treatment of unresectable or metastatic melanoma in patients with BRAF mutations
combo with Vemurafenib
underlined toxicity for dabraf/tramet *
squamous cell carcinoma (deja vu)
why would the combo of encorafenib and binimetinib be preferred over dabraf/tramet? *
less fevers
Ipilimumab ____ inhibitor
CTLA-4
when to use Nivolumab/Ipilimumab combo
untreated, unresectable stage III or IV
Ipilimumab approved in what setting(s)
unresectable and 1st line metastatic
weird toxicity with ipilimumab
tumor growth prior to immune system activation
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
after
new lesions
how many grades of toxicity are there? What side is worse?
4 on a scale 1-4, 4 is bad
which toxicities take the longest to reverse (and may not reverse at all)?
endocrine
two most common toxicities of ipilimumab
skin and GI
what grades of toxicity do you add a steroid?
3 and 4
T or F: chemo rarely cures any patient in the metastatic setting of melanoma
True*
2 immunotherapy things underlined on slide 65 but she didnt talk about it much at all
IL-2
Interferon alfa (fallen out of favor)
