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BPT Oncology > Melanoma > Flashcards

Melanoma Flashcards

1
Q

What percentage of all cancers dx in 2019 was melanoma?

A

11%

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2
Q

What are risk factors for melanoma?

A 
Unprotected sun exposure
Fair skin, light eye colour, light hair, tendaency to burn
Dysplastic naevi
Immunosuppresion
Family history
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3
Q

Which genes are related to family hx of melanoma?

A

CDKN2A

CDK4

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4
Q

What are prognostic factors?

A 
Tumour thickness
Mitotic rate
Ulceration
Primary tumour location
Old age and male sex
Lymph node
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5
Q

What is the mx of stage 0?

A

Surgical resection

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6
Q

What is the mx of stage 1?

A

Surgical resection + consider sentinel LN bx

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7
Q

When is adjuvant RTx considered?

A

Stage II and III

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8
Q

Which mutation is the most important? Which is the prevalence?

A

BRAF

40%

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9
Q

What are other mutations are tested for?

A

NRAS

C-KIT

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10
Q

Which drugs inhibitor BRAF?

A

Vemurafenib and dabrafenib

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11
Q

What is the problem with BRAF inhibitors?

A

Development of resistance

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12
Q

Through which mechanism does resistance to BRAF inhibitors occur?

A

Via the MAPK reactivation through MEK

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13
Q

What do you combine BRAF inhibitors with?

A

MEK inhibitor

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14
Q

What is the name of MEK inhibitors?

A

Trametinib + cobimetinib

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15
Q

How do cancers evade the immune system?

A

Loss of antigenicity
Gain of immunosuppressive properties
Creating an immunosuppressive environment

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16
Q

What is the target of ipilimumab? What is the result?

A

CTLA4

Propagates T-cell activation

17
Q

What are the PD-1 inhibitors?

A

Pembrolizumab

Nivolumab

18
Q

What is the roll of PD-1 in the immune response?

A

Its activation causes downregulation of T cell response

19
Q

What is the response rate with PD-1 inhibitors? What is hte median overall survival?

A

~50%

32-37 months

20
Q

Is there benefit of combining ipilimumab and nivolumab

A

Yes - Response rate 61 vs 11% (CTLA4 alone)

21
Q

What is the toxicity rate with combination immunotherapy?

A

44% grade 3 + 4 AE

22
Q

What are the most common effected organs from immunotoxicity?

A 
Skin
GIT
Liver
Endo (thyroid, adrenals, pituitary)
Lung
23
Q

When is the peak onset of immunotoxicity?

A

4-12months

24
Q

What is most common site of AE with ipilimumab and nivolumab respectivity?

A

GIT

Endocrine

25
Q

How do you manage mild/moderate/severe immunotoxicity?

A

Mild - symptomatic mx

Moderate - PO pred 1mg/kg daily. Omit next dose until symptoms resolve

Severe - IV corticosteroids with wean over 4 weeks once severe resolve. Consider alt. immunosuppressive if not responding within 5-7 days. Consider ceasing agent.

26
Q

What is the most common endocrinopathy?

A

Thyroiditis

27
Q

What is pseudoprogression?

A

Phenomenon of apparent progression that then regresses

BPT Oncology (17 decks)

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