Melanoma

Question 1

What is a melanoma

Answer 1

Cancer that arises in melanocytes

Question 2

What are the most common of mutations seen in melanoma

Answer 2

MAP kinase (enhance proliferation) PI3K/AKT (diminishes apoptosis)

Question 3

What are genetic risk factors for melanoma

Answer 3

Family or personal history of melanoma, history of atypical skin lesions, age, complexion/hair and eye color

Question 4

What are the enviornmental risk factors for melanoma

Answer 4

Sun/UV light exposure, multiple sunburns, residence in sun/nearer to equator

Question 5

What are the ABCDEs of screening for melanoma

Answer 5

A: Asymmetry
B: Boarder
C: Color
D: Diameter
E: Evolving

Question 6

T/F: The deeper melanoma grows the less overall survival

Answer 6

True

Question 7

What is the first line treatment for a patient with stage 0, 1a, 1b, 2 melanoma

Answer 7

Excision with or without a nodal biopsy

Question 8

What is the first line treatments for a patient with stage 3 (nodal involvement)

Answer 8

Excision, Radiation with or without Adjuvant therapy

Question 9

What are the possible adjuvant therapy treatments for

Answer 9

Nivolumab, Pembrolizumab, Dabrafenib/Trametinib

Question 10

What are the first line treatment for metastatic melanoma

Answer 10

Nivolumab, Pembriolizumab, Nivolumab/Ipilimumab

Question 11

What chemotherapy can be given if a patient has a positive BRAF V600 mutation in Stage 3 melanoma, Stage 4 melanoma

Answer 11

Dabrafenib/trametinib/ Dabrafenib/trametinib, vemurafenib/cobimetinib, Encorafenib/binimetinib

Question 12

What is the most important oncology clinical trial

Answer 12

Overall survival

Question 13

T/F: Immunotherapy causes immediate reduction in tumor therapy

Answer 13

False: A patient may have pseudoprogression in the first weeks and when therapy is continued the tumor shrinks

Question 14

What are the immunotherapy categories

Answer 14

PD-1 inhibitors and CTLA-4 inhibitors

Question 15

What is the mechanism of action for CTLA-4 inhibitors, what is the one CTLA-4 inhibitor

Answer 15

Blocks CTLA-4 in order to increase the likelihood that a T-cell is activated by APC, Ipilimumab

Question 16

T/F: Ipilimumab has the capability of causing high adverse effects and death but also curing melanoma

Answer 16

True

Question 17

What is the MOA of PD-1 inhibitors, what are the PD-1 inhibitors

Answer 17

Blocking the interaction of PD-1 and programmed cell death ligand 1 (PDL-1) resulting in decreased cell anergy/ Nivolumab and Pembrolizumab

Question 18

What is the risk of mixing a PD-1 inhibitor and a CTLA-4 inhibitor. risk

Answer 18

Increase response with much more toxicity that is more intense and frequent

Question 19

What mutation is seen in half of the patients with melanoma

Answer 19

BRAF mutation

Question 20

What is the MOA of BRAF inhibitors, what are the BRAF inhibitors

Answer 20

Inhibition of mutant BRAF V600E and V600K/ Vemurafenib, Dabrafenib, Encorafenib

Question 21

What patients cant recieve BRAF inhibitors, why

Answer 21

BRAF wild type patients, the melanoma becomes worse

Question 22

What are the adverse effects of BRAF

Answer 22

New primary malignancies (Keratoacanthomas), skin toxicities, Fevers, QTc prolongation (Hold if greater than 500 ms), Increased creatinine

Question 23

What are the MEK inhibitors

Answer 23

Cobimetinib, Trametinib, Binimetinib

Question 24

What are the adverse effects of MEK inhibtors

Answer 24

Cardiomyopathy (if LEVF is less than 50% no use), DVT and pulmonary embolism, ocular toxicity

Question 25

When the patients have combination of BRAF and MEK inhibitors what are the most common adverse effects

Answer 25

Pyrexia, serum creatinine increase

Question 27

Which cancer drug acts as a vector for a protein that stimulates an immune response on the cancer, what is the major side effect

Answer 27

Talimogene Laherparepvec, herpes

Question 28

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

Answer 28

True