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PHRM 864 > Exam 2: Melanoma > Flashcards

Exam 2: Melanoma Flashcards

1
Q

Melanoma

A

results from the malignant transformation of skin melanocytes or from the transformation of preexisting nevocellular nevi

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2
Q

Factors identified in the progression of melanoma

A
  • BRAF
  • MEK
  • PI3K/AKT
  • c-KIT
  • Cytotoxic T lymphocytes
  • PD-1
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3
Q

Superficial spreading melanoma

A
  • 70% of cases
  • appears flat but subsequently becomes irregular and asymmetrical
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4
Q

Nodular Melanoma

A
  • strictly vertical growth
  • raised and asymmetrical
  • head, neck, trunk
  • more common in men
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5
Q

Lentigo Maligna Melanoma

A
  • presents on the face of elderly patients
  • tan lesion with areas of brown and black
  • has low propensity to metastasize
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6
Q

Arcral lentiginous melanoma

A
  • frequently presents on the palms, soles, or under nail beds
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7
Q

Uveal melanoma

A
  • occular melanoma
  • often metastasis in liver
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8
Q

A: ABCDE

A

asymmetric

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9
Q

B: ABCDE

A

have irregular boarders

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10
Q

C: ABCDE

A

wide variety of colors

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11
Q

D: ABCDE

A

Diameter of > 6 mm

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12
Q

E: ABCDE

A

Evolution of a mole may be indicative of neoplastic transformation

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13
Q

Diagnostic Work up

A
  • history and pE
  • biopsy of suspected lesion
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14
Q

What should happen if melanoma is a clinical or pathologic stage IV?

A

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

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15
Q

Surgery

A
  • surgery beyond localized disease is thought to be palliative
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16
Q

Radiation

A
  • could be offered in the adjuvant setting for select patients with positive lymph nodes and high risk relapse
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17
Q

adjuvant therapy

A
  • traditionally not warranted in the past, but newer data has changed that recommendation
  • recommendations are based on stage
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18
Q

Stage IB or IIA lymph node negative treatment overview

A

clinical trial or observation

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19
Q

Stage IIB or IIC lymph node negative treatment overview

A

clinical trial, observation, pembrolizumab

20
Q

Stage III treatment overview

A
  • nivolumab
  • pembrolizumab
  • dabrafenib/trametinib (if BRAF mutat)
    ±
    radiation or observation
21
Q

Adjuvant Nivolumab

A
  • toxicities were higher in ipilimumab compared to nivolumab
  • is now NCCN category 1 recommendation in adjuvant setting
22
Q

Adjuvant Pembrolizumab

A
  • pembro improved recurrence free survival and reduced risk of distant metastases
23
Q

Adjuvant Dabrafenib/Trametinib

A
  • completely resected, stage III disease with BRAF V600E or V600K mutations AND SLN metastases > 1 mm
24
Q

First line treatment options for metastatic melanoma eligible for anti-PD1 monotherapy

A
  • nivolumab
  • pembrolizumab
  • nivolumab + relatlimab-rmbw
25
Q

First line treatment options for metastatic melanoma with BRAF V600 mutation

A
  • dabrafenib/trametinib
  • vemurafenib/cobimetinib
  • encorafenib/binimetinib
26
Q

Certain circumstances metastatic treatment options

A
  • nivolumab/ipilimumab
  • associated with more toxicities
27
Q

In general, immunotherapy and targeted therapy are preferred for treatment of what?

A

unresectable or distance metastases

28
Q

when can chemo be considered?

A
  • patients not eligible for any of the recommended immunotherpay options due to progression on prior therapy, unacceptable toxicity, or comorbidities
29
Q

What should be started initially for quicker onset of action?

A
  • targeted therapy
  • immunotherapy can take weeks to see effect
30
Q

all patients with metastatic disease should be tested for what?

A

BRAF mutations

31
Q

Vermurafenib

A
  • BRAF V600E
  • development of squamous cell carcinoma
32
Q

Cobimetinib

A

in treatment of unresectable or metastatic melanoma in patients with BRAF V600E or V600K mutations
- in combo with vemurafenib

33
Q

Dabrafenib

A
  • used in BRAF V600E or BRAF V600K
  • single agent or with trametinib
  • squamous cell carcinoma
34
Q

Trametinib

A
  • reversibly and selectively inhibits MEK 1 and 2 activation and kinase actiivty
35
Q

Inhibition of MEK 1 and 2

A

leads to decreased cellular proliferation, cell cycle arrest, and increased apoptosis

36
Q

Pembrolizumab

A
  • pembro has less toxicities than ipilimumab and PFS and OS were statistically longer
37
Q

Combo Nivolumab/Ipilimumab Treatment

A
  • untreated, unresectable stage III or IV
38
Q

Ipilimumab

A
  • CTLA-4 inhibitor to promote antitumor immunity
  • some patients will have tumor growth prior to immune system activation
39
Q

Immune related response criteria

A
  • response after initial increase in disease
  • reduction in total tumor burden after presence of new lesions
  • very important to understand so therapy isnt stopped based on what was thought to be progesssing disease
40
Q

Immunotherapy toxicities

A
  • rash, pruritis
  • liver toxicities
  • diarrhea, colities
  • neuropathy
  • pneumonitis
  • musculoskeletal pain
  • diabetes
  • hypophysitis
41
Q

Colitis treatment

A
  • steroids
42
Q

Diabetes treatment

A
  • insulin in all patients
43
Q

Hypophysitis treatment

A
  • hydrocortisone
44
Q

Chemo in the metastatic setting

A
  • rarely cures any patient
45
Q

Melanoma Screening

A

full body self exam

46
Q

Melanoma Prevetion

A
  • sun protection
  • SPF > 15

PHRM 864 (10 decks)

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