Incidence of BRAF in melanoma
50% of melanomas positive for BRAF -most common V600E
No prognostic value, predictive of response to BRAF
BRAF inhibitors
Dabrafenib(inhibits all V600 mutations),
vemurafenib (selective V600E mutations)
encorafenib
Response rate 48% in metastatic disease
BRAF side effects
Rash, diarrhoea, photosensitivity
squamous cell CA (In patients with RAS)
Mek inhibitors
Trametinib, cobimetinib, binimetinib
Immunotherapy of choice for melanoma
Pembrolizumab
Clinical TLS
Lab TLS along with either increased serum creatinine, seizure, cardiac arrhythmia or sudden death
Most common subtype of melanoma
Superficial spreading
Melanoma with worst prognosis
Nodular
Immunohistochemistry markers of melanoma
S-100, Melan A
Feature of melanoma that causes upgradation of staging
Presence of ulceration
Stage 1 and 2 treatment
Surgery+ SLNB
Management of positive SLNB
Total LN dissection done only if clinically positive nodal basin
Else - strict follow up protocol
Completion LN dissection on clinical or radiological progression
Role of CTLA4 inhibitor in adjuvant setting
Adjuvant Nivolumab better than Ipilimumab for resected Stage 3 disease
Management of stage 4 disease
Metastasectomy - in absence of locoregional disease and metastasis confined to single site
Mutation testing - targeted tgerapy if mutation positive
Anti PDI - Pembrolizumab or Nivolumab
Ipilimumab + Nivo if LDH high
TKI in RCC
Sunitinib, Sorafenib - VEGF inhibition
HTN is predictive marker (More with sorafenib)
Rash is predictive marker -more the rash, more response
A/E Sorafenib
HTN
Handfoot skin reaction
Diarrhoea, rash, alopecia
mTOR inhibitors in RCC
Everolimus