CANCER- MELANOMA Flashcards Preview

FINAL YEAR PHARMACY > CANCER- MELANOMA > Flashcards

Flashcards in CANCER- MELANOMA Deck (26):
1

There are two types of non-melanoma skin cancers, what are these?

Basal Cell carcinoma
Squamous cell carcinoma

2

Where is melanoma commonly found in women and men?

Men: backs and faces
Women: arms and legs

3

We use the ABCDEF system to identify melanomas. What does this stand for?

A: Asymmetrical
B: Border
C: colour (colour varies throughout)
D: Diameter (larger than a pencil eraser)
E: Elevation off the skin
F: Funny mole

4

What are the risk factors for melanoma?

Sun exposure: Exposure to intermittent intense sun is more of a risk than prolonged exposure to UV radiation. Blistering sun burn in childhood a risk!!

Number of Moles

Skin type: Fair haired pale skin more likely

Family history

5

What does diagnosis of Melanomas involve?

patients usaully present with a changing or enlarging or irritating lesion

Mole examined under a dermascope

Excisional biopsy done to remove whole lesions

Histopathology: to determine stage and type of melanoma

Physical examination: lymphadenopathy (see if its spread to lymph nodes)

6

How do we treat stage 0/1/2/3 melanoma tumours?

Excision of the tumour followed by wide local excision to remove a good margin of the healthy tissue

7

How do we treat stage 4 melanoma tumours?

these are advanced tumours and are resectable (i.e. they can't be cut out)

We treat with chemotherapy

Can use biological therapies: ipilimumab, vemurafenib

8

What is the prognosis with Advanced/ unresectable melanoma (stage 4)?

10 year survival is under 10%

9

Ipilimumab was the first agent to show an increase in overall survival in advanced/ unresectable malignant melanomas. What is this?

A recombinant human monoclonal antibody that will bind to CTLA-4 and block its interaction with its ligands CD80 and CD86.
It is recommended for use after a previous therapy has been tried (e.g. chemotherapy drug Dacarbazine) as its the most expensive cancer drug

10

Ipilimumab works by blocking CTLA-4. Its mechanism of action is INDIRECT possibly through T cell mediated anti tumour responses. What does this mean?

CTLA-4 is a molecule that serves as an immune checkpoint that results in down regulation of T-cell activation. This therefore prevents the immune system attacking cancer cells.

By blocking CTLA-4's action, Ipilimumab stimulates the anti-tumour T cell response and lots of T cells are produced through unrestrained T cell proliferation

11

Remember: Ipilumumab blocks CTLA-4's action which TURNS T CELLS ON

It therefore has an indirect action: it doesn't kill the cell directly but makes the immune system do it!!

12

What are the side effects of Ipilumumab??

Diarrhoea
Rash
Pruritus
Fatigue
Nausea & vomitting
Decreased appetite
Abdominal pain

13

Advanced/ unresectable melanoma (stage 4) can be treated using Dacarbazine. what is this?

Chemotherapy agent
A DNA alkylating drug
No significant effect on overall survival

14

What drug can be used in patients that have the BRAF V600 gene mutation?

Vemurafenib

Its a BRAF (a tyrosine kinase) inhibitor

Its an oral drug

15

Vemurafenib is a GOOD drug in Malignant melanoma treatment.

Around 90% of patients have tumour regression quickly when treated with this drug!

Overall median survival is 15 months

16

Vemurafenib is not very well tolerated by patients as it has A lot of side effects.
What are the side effects of Vemurafenib? Try and list 6!!

Fatigue
Joint Pain (patients may need pain killers)
Rash (patients may need emollient, antihistamine or painkillers)
Sensitivity to the sun
Nausea
Alopecia
Pruritus (itching)
Headache

17

Vemurafenib causes sensitivity to the sun. What should we advise patients do about this?

SPF 30-50 suncream needed in ALL WEATHERS (so even when its cloudy!)
wear long sleeves
Apply a UV resistant film to your windows

Really decreases QoL :(

18

Whats the strange side effect that Vemurafenib can produce?

Can actually induce a minor form of skin cancer: Cutaneous squamous cell carcinoma

They can be easily treated by surgical removal but patients should be advised to look out for and new/ changing skin lesions!

19

Vemurafenib is advised by NICE for patients with Malignant Melanomas who have the BRAF V600 mutations.

It has many drug interactions as its metabolised by the Cytochrome P450 enzymes

20

Dabrafenib is a BRAF inhibitor like Vemurafenib.

It has similar efficacy to Vemurafenib.
Its advantage is that it is better tolerated.

What are its side effects? (hint: 5 are the same as Vemurafenib, 2 new ones)

Fatigue
Joint pain
Rash
Nausea
Headache

Diarrhoea
FEVER- Patients should report temperatures over 38.

21

Dabrafenib has a slightly unusual side effect like Vemurafenib. What is this?

That is can actually cause a minor form of skin cancer: Cutaneous squamous cell carcinoma.
Patients should check for it, but it can be easily treated with surgery

22

Whats the very rare (1%) side effect that can be caused by Dabrafenib?

UVEITIS (swelling in the eye)
Can damage vision if its not treated
patients need to report blurry vision, eye redness or irritation

23

What route of administration are Vemurafenib and Dabrafenib?

ORAL (tablets

Vemurafenib: taken twice a day WITH food
Dabrafenib: taken twice a day WITHOUT food (empty stomach)

24

How does Pembrolizumab, a new drug, work?

It is an anti- PD-1 (programmed cell death receptor inhibitor)
Its a humanised monoclonal antibody
Its given by IV infusion
It blocks the interaction between PD-1 (a programmed cell death receptor) and its ligands: PD-L1 and PD-L2
By doing this: it takes the breaks off the immune system (see notes)

25

When is Pembrolizumab indicated for treatment of skin cancer?

For advanced Malignant melanoma following therapy with either ipilimumab or one of the BRAF inhibitors (Vemurafenib or Dabrafenib)

Its doesn't have a UK license but it available under the UK Early Access to Medicines Scheme!

26

What are the side effects of Pembrolizumab?

Fatigue
Cough
Nausea
Pruritis (itching)
Rash
Decreased appetite
Constipation
Diarrhoea