Melanoma Flashcards
What is a melanoma
Cancer that arises in melanocytes
What are the most common of mutations seen in melanoma
MAP kinase (enhance proliferation) PI3K/AKT (diminishes apoptosis)
What are genetic risk factors for melanoma
Family or personal history of melanoma, history of atypical skin lesions, age, complexion/hair and eye color
What are the enviornmental risk factors for melanoma
Sun/UV light exposure, multiple sunburns, residence in sun/nearer to equator
What are the ABCDEs of screening for melanoma
A: Asymmetry B: Boarder C: Color D: Diameter E: Evolving
T/F: The deeper melanoma grows the less overall survival
True
What is the first line treatment for a patient with stage 0, 1a, 1b, 2 melanoma
Excision with or without a nodal biopsy
What is the first line treatments for a patient with stage 3 (nodal involvement)
Excision, Radiation with or without Adjuvant therapy
What are the possible adjuvant therapy treatments for
Nivolumab, Pembrolizumab, Dabrafenib/Trametinib
What are the first line treatment for metastatic melanoma
Nivolumab, Pembriolizumab, Nivolumab/Ipilimumab
What chemotherapy can be given if a patient has a positive BRAF V600 mutation in Stage 3 melanoma, Stage 4 melanoma
Dabrafenib/trametinib/ Dabrafenib/trametinib, vemurafenib/cobimetinib, Encorafenib/binimetinib
What is the most important oncology clinical trial
Overall survival
T/F: Immunotherapy causes immediate reduction in tumor therapy
False: A patient may have pseudoprogression in the first weeks and when therapy is continued the tumor shrinks
What are the immunotherapy categories
PD-1 inhibitors and CTLA-4 inhibitors
What is the mechanism of action for CTLA-4 inhibitors, what is the one CTLA-4 inhibitor
Blocks CTLA-4 in order to increase the likelihood that a T-cell is activated by APC, Ipilimumab
T/F: Ipilimumab has the capability of causing high adverse effects and death but also curing melanoma
True
What is the MOA of PD-1 inhibitors, what are the PD-1 inhibitors
Blocking the interaction of PD-1 and programmed cell death ligand 1 (PDL-1) resulting in decreased cell anergy/ Nivolumab and Pembrolizumab
What is the risk of mixing a PD-1 inhibitor and a CTLA-4 inhibitor. risk
Increase response with much more toxicity that is more intense and frequent
What mutation is seen in half of the patients with melanoma
BRAF mutation
What is the MOA of BRAF inhibitors, what are the BRAF inhibitors
Inhibition of mutant BRAF V600E and V600K/ Vemurafenib, Dabrafenib, Encorafenib
What patients cant recieve BRAF inhibitors, why
BRAF wild type patients, the melanoma becomes worse
What are the adverse effects of BRAF
New primary malignancies (Keratoacanthomas), skin toxicities, Fevers, QTc prolongation (Hold if greater than 500 ms), Increased creatinine
What are the MEK inhibitors
Cobimetinib, Trametinib, Binimetinib
What are the adverse effects of MEK inhibtors
Cardiomyopathy (if LEVF is less than 50% no use), DVT and pulmonary embolism, ocular toxicity
When the patients have combination of BRAF and MEK inhibitors what are the most common adverse effects
Pyrexia, serum creatinine increase
Which cancer drug acts as a vector for a protein that stimulates an immune response on the cancer, what is the major side effect
Talimogene Laherparepvec, herpes
T/F: Since immunotherapy takes longer than expected if someone has symptoms from there melanoma they should be given a BRAF and MET inhibitor if they have the right mutations
True
