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Hematology, oncology > Melanoma > Flashcards

Melanoma Flashcards

1
Q

management of brain mets in melanoma

A

IF resectable isolated LARGE brain metastasis → metastasectomy (surgery)
Multiple brain metastasis
IF resectable → surgery or radiosurgery
IF not resectable → whole brain radiation therapy

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2
Q

cutaneous vs. non cutaneous melanoma

A 
cutaneous = typical melanoma
noncutaneous = extremely rare. melanoma that develops in other areas of the body where melanocytes are present. Ocular melanoma. Mucosal melanoma.
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3
Q

stage at which melanoma is typically diagnosed

A

Most cases of malignant melanoma are diagnosed at an early stage, when surgical excision can be curative.

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4
Q

Treatment options for melanoma

A

1) checkpoint inhibitors (pembrolizumab, nivolumab]
2) anti-cytotoxic T-lymphocyte-associated protein 4 [CTLA-4] antibody [ipilimumab]
3) targeted therapy .
4) RT for local control

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5
Q

ipilimumab mechanism

A

anti-cytotoxic T-lymphocyte-associated protein 4 [CTLA-4] antibody

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6
Q

Role for chemo in metastatic melanoma?

A

None. Previously used but never demonstrated an OS benefit.

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7
Q

Prevalence of V600 mutation in the BRAF gene in melanoma

A

High – 50%

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8
Q

BRAF mutation is involved in what pathway

A

MAPK

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9
Q

Tolerability of BRAF and MEK inhibitor therapy

A

well tolerated

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10
Q

Management of oligometastatic disease

A

surgical metastasectomy

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11
Q

Critical prognostic lab in melanoma

A

LDH

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12
Q

what is talimogene?

A

attenuated oncolytic herpes simplex virus that contains the granulocyte macrophage colony stimulating factor gene

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13
Q

Options for Management of metastatic melanoma

A
  • Iplimumab + nivolumab (ipi-novo)
  • nivolumab single agent
  • pembrolizumab single agent
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14
Q

BRAF inhibitors

A

Encorafenib
Vemurafenib
Dabrafenib

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15
Q

Definition of microscopic satelites

A
  • Any discontinuous nest of intralymphatic metastatic cells >0.05 mm in diameter that are clearly separated by normal dermis (not fibrosis or inflammation) from the main invasive component of melanoma by a distance of at least 0.3 mm.
  • Basically tumor has spread to small areas of skin
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16
Q

Melanoma staging based on

A

1) Thickness
2) presence of ulceration
3) nodal mets, distant mets

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17
Q

Prevalance of BRAF mutation

A

High – 50%

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18
Q

Targeted therapies for melanoma target…

A
  • BRAF
  • NRAS
  • MEK
  • KIT
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19
Q

N1 in melanoma means

A

one lymph node

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20
Q

N2 in melanoma means

A

2 or more nodes

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21
Q

“In transient” or “satelite” metastasis means

A
  • deposit of melanoma that is distinct from primary tumor and is in transient or going toward nodal basin
22
Q

N2 means

A

4 or more nodes

23
Q

Management of involved sentinel node (microscopic)

A
  • no longer do completion specific lymph node dissection
24
Q

Efficacy of adjuvant radiation in melanoma

A
  • improves local control of bulky disease but not OS
25
Q

Role for adjuvant radiation

A
  • high risk disease (will improve local control but won’t have any effect on long term survival)
26
Q

BRAF inhibitors

A

Vemurafenib

Dabrafenib

27
Q

MEK inhibitor

A

Trametinib

28
Q

General consensus on MEK inhibition

A
  • not typically used as monotherapy, toxic
29
Q

Caveat about using BRAF inhibitors

A

1) Must always be V600E mutation, not a variant BRAF mutation (this can harm patient through paradoxical activation of pathway)
2) Resistance is a problem so response can abate over time

30
Q

Combination vs. single agent targeted therapies

A
  • always combination
31
Q

Prognostic importance of elevated LDH

A

very poor prognosticator

32
Q

KIT targeted therapy

A

Imatinib

33
Q

Pembro SE’s

A
  • hypothyroidism/hyperthyroidism
  • pneumonitis
  • colitis
  • hepatitis
  • skin rashes
34
Q

Ipi SE’s

A
  • colitis
  • hepatitis
  • hypophisitis
35
Q

Combined or single agent CPI in melanoma?

A

Combined – Ipi + nivo, then can use single agent as maintenance therapy

36
Q

Importance of PD-L1 expression

A
  • heterogenous and prone to sampling bias so not mandated and shouldn’t get treatment decisions
37
Q

trade name for talimogene

A

TVEC

38
Q

distant mets relatively common in melanoma

A

brain mets

39
Q

Responses to targeted therapies for brain mets in general

A
  • good response rates but not as good as with outside of the brain
40
Q

when to use ipi-nivo for metastatic melanoma

A

IF large burden of symptomatic disease, elevated LDH (very toxic regimen) –> ipi-nivo
IF asymptomatic –> single agent PD1

41
Q

Can melanoma lack pigment?

A

Yes, all changing lesions, regardless of color should be biopsied

42
Q

Mutations that account for the majority of mutations found in cutaneous melanoma

A
  • BRAF
  • NRAS
  • NF1
43
Q

Most common AE of dabrafenib = trametinib

A

fever/pyrexia (typically occurs early in treatment with incidence decreasing over time)

44
Q

Most commonly identified somatic mutation in uveal melanoma

A

GNAQ

45
Q

Biology of uveal melanoma

A
  • completely distinct from cutaneous
  • No BRAF mutation
46
Q

First line management of metastatic uveal melanoma

A
  • Tebentafusp
  • *Doesn’t respond to checkpoint inhibitors
47
Q

management of retinal detachment from MEK inhibitors

A
  • IF improvement within 3 weeks of therapy interruption, resume (generally doesn’t cause irreversible loss of vision or serious eye damage)
48
Q

First line options for stage IV merkel cell carcinoma

A

Avelumab
Pembro

49
Q

Most commonly identified mutation in familial forms of melanoma

A

CDKN2A

50
Q

Gene mutation more common in mucosal melanoma

A

KIT

51
Q

Thickness at which sentinel lymph node biopsy is needed (board question)

A

0.8 mm

Hematology, oncology (218 decks)

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