Skin Cancer Pharm Flashcards
What are some common sites of metastasis of skin cancer?
intestines, lung and brain
What are the drugs for basal cell carcinomas?
- Aminolevulinic Acid
- Porfimer
- Sonidegib
- Vismodegib
What are BCCs typically caused by?
They are usually caused by a combination of cumulative and intense, occasional sun exposure.
Are BCCs likely to metastasize?
BCC almost never spreads (metastasizes) beyond the original tumor site. Only in exceedingly rare cases can it spread to other parts of the body and become life-threatening.
It shouldn’t be taken lightly, though: it can be disfiguring if not treated promptly.
What are the treatment options for BCCs?
- surgical excision (Mohs surgery has the best cure rate)
- cryotherapy
- radiation
- photodynamic therapy (aminolevulinic acid)
- targeted therapy (for advanced BCCs)
What is a common signaling mutation in BCCs?
Hedgehog signaling, an important pathway in embryogenesis and organ maturation but one that is typically quiescent by adulthood except for minor tissue maintenance, but can also become dysregulated in some forms of cancer, including BCC.
Hedgehog mutations have also been implicated in what kinds of cancers?
- rhabdomyosarcomas
- medulloblastomas
What are some of the pathological consequences of upregulated HH signaling?
-upregulation of anti-apoptotic protein Bcl-2, induction of VEGF and angiogenesis
How do drugs attack abnormal HH signaling?
They (Vismodegib/Sonidegib) must act at or below the level of the transmembrane protein SMO (smoothened) because the pathway is ligand independent, so blocking HH binding to PTCH1 (protein patched homolog 1) is ineffective
What are the AEs of Vismodegib and Sonidegib
- Teratogenic female AND male (makes sense since HH is invovled in organ formation)- up to 20 months after use in women and 8 months in semen in men
- alopecia
- endocrine dysfunction
- GI toxicity
- elevated serum creatinine
What drugs are available for squamous cell carcinoma?
- aminolevulinic acid
- afatinib
- Cetuximab
What are squamous cell carcinomas?
“Squamous cell carcinoma (SCC) is an uncontrolled growth of abnormal cells arising in the squamous cells, which compose most of the skin’s upper layers (the epidermis). SCCs often look like scaly red patches, open sores, elevated growths with a central depression, or warts; they may crust or bleed. They can become disfiguring and sometimes deadly if allowed to grow.
What are the treatment options for SSCs?
- surgery
- photodynamic therapy (aminolevulinic acid)
- targeted (afatinib and Cetuximab)
- conventional drugs (bleomycin, docetaxel, hydroxyurea, fluorouracil
What is Afatinib? Cetuximab?
PO irreversible TKI for EGFR and HER2
Cetuximab- EGFR monoclonal bloking phosphorylation and activation of kinases
Toxicities of targeted drugs?
These drugs can affect virtually any organ in the body due to their chronic use resulting in accumulation. Make sure to monitor closely
What are the major toxicities of EGFR ddrugs?
- derm rxns especially common (rash, dry skin, etc.)
- GI toxicity
- rarely CV toxicity
What are the drug options of actinic keratosis?
- Diclofenac
- Imiquimod
- Ingenol Mebutate
- Aminolevulinic acid
- Methylaminolevulinic acid
What is actinic keratosis?
Actinic keratosis, also known as a solar keratosis, is a scaly or crusty growth (lesion) that most often appears on areas of the body commonly affected by the sun. You’ll often see the plural, “keratoses,” because there is seldom just one. In the beginning, actinic keratoses are frequently so small that they are recognized by touch rather than sight. It feels as if you were running a finger over sandpaper. Patients may have many times more invisible (subclinical) lesions than those appearing on the surface.