Melanoma Flashcards
Interferon-alfa 2b, Peginterferon-alfa 2a, Peginterferon-alfa 2b
Melanoma
Interferon Immunotherapy
o Role of interferon in adjuvant therapy in high-risk pts after surg resection of melanoma is controversial. But may be utilized
MOA
• Basically, Complex MOA, man-made parts of imm sys thrown in to help body fight CA cells
• Interferon = prot secreted in response to viral infxn through binding at specific mem recep on cell surface..
- binds tumor cells and kills
• Pegalated interferon = covalent conjugate of recombinant interferon, which is biologically active component
- Revs up imm sys so have imm response against & kills CA cell
ADE
• Flu-like symptoms
• Fatigue
• Hepatotoxicity
• Anorexia, weight loss, early satiety
• Neuropsychiatric symptoms (e.g. mood chgs, depression, confusion, drowsiness, dizziness
• Ocular toxicity
• Autoimmunity (thyroid, pancreatic)
• Taste changes
• Sexual dysfunction
• Hair loss/ thinning
• Pain at the injection site (since frequent injections)
Interleukin-2 (IL-2)
Melanoma
Immunotherapy
INDICATIONS
• Approved for tx of metastatic melanoma and renal cell carcinoma
• Not utilized as much anymore
MOA
- not sure
• Activation of cellular immunity (lymphocytosis, eosinophilia, thrombocytopenia)
• Production of cytokines:
Tumor necrosis factor (TNF), IL-1, and gamma interferon
ADE
• Fever and chills 2-3 hrs after first or second dose
• Mild- moderate hypotension & tachycardia
• Oliguria (check urine output)
• **Capillary leak syndrome: Hypotension, visceral edema, dyspnea, tachycardia, arrhythmia
• Pruritus
• Pulmonary congestion
• Bone marrow suppression
• Increase in LFTs
• Renal insufficiency
Ipilimumab
Melanoma TARGETED TREATMENTS • Recombinant, human monoclonal antibody MOA • Binds to cytotoxic T-lymphocyte-associated antigen 4 (**CTLA-4) o T-cell medicated antitumor immune response ADE • Immune mediated *enterocolitis • Immune mediated *hepatitis • Immune mediated *dermatitis • Immune mediated *neuropathies • Immune mediated *endocrinopathies - *manage ADE w/ systemic corticosteroids
Vemurafenib
Melanoma TARGETED TREATMENTS MOA • Kinase inhibitor of some forms of BRAF serine-threonine kinase, including mutated *BRAF *V600E ADE • *Papilloma of the skin: Skin tag, wart • Skin rash/ itching • Sensitivity to sunlight • *Hand foot syndrome (dryness in palms/foot soles) • Hair loss/ thinning • Nausea/ vomiting • Arthralgia • Fatigue • Blurred vision • Diarrhea • Squamous cell carcinoma • QT prolongation • Steven Johnson Syndrome
Dabrafenib
Melanoma TARGETED TREATMENTS - *take on empty stomach MOA • Kinase inhibitor that reversibly inhibits mitogen-activated extracellular signal regulated kinase 1 (MEK1) and MEK2 activation and of MEK1 and MEK2 activity • Inhibits *BRAF V600 mutation-positive melanoma cell growth when used in combination with dabrafenib, there is greater and prolonged inhibition compared with either drug alone ADE • *Papilloma of the skin: Skin tag, wart • Skin rash/ itching • Hand foot syndrome • Hair loss/ thinning • Night sweats • Arthralgia • Vision changes: Iritis • Squamous or basal cell carcinoma • Anemia • Neutropenia • Thrombocytopenia • Diarrhea/ constipation • Nausea/ vomiting • Blood clot • Peripheral edema • Elevated liver enzymes • Hyperglycemia • Hypokalemia • Hypophosphatemia
Trametinib
Melanoma TARGETED TREATMENTS INDICATIONS • Malignant melanoma, Unresectable or metastatic, with BRAF V600E or V600K mutation, mono therapy • Malignant melanoma, Unresectable or metastatic, with BRAF V600E or V600K mutation, in combination with dabrafenib MOA - targets *MEK tyrosine kinase in the RAS/RAF/MEK/ERK pathway ADE • Fatigue • Rash • Diarrhea • Prolonged QT • Penumonitis • Blood clot • Squamous or basal cell carcinoma • Night sweats • Hyperglycemia • Hypophosphatemia • Hyponatremia • Hypokalemia • Anemia • Leukopenia • Elevated liver enzymes
