Squamous carcinoma low grade. Vemurafenib
General considerations
• Surgery:
– At least 2 cm margin (body)
– No sentinel node for lesion less 0,75- 1 mm
– Lynphadene...
Adyuvant

Interferon 1 year

One node with microscopic
infiltration: No Interferon
New drugs in the adjuvant setting in
cl...
VITILIGO after
Interferon treatment
Flow sheet for metastatic melanoma
Bad performance, pluripathology, clinical fragility: Paliative Care

CNS metastasis and...
Summary T-cell balance

APC

CD-28

CTLA-4

T-cell

PD-1
Tumor

Kill
Ipilimumab
dermatologi
c toxicity:
Pruritus,
Rash,
vitiligo
Ipilimumab “plateau”
Phase I Drug-Related Grade 2 and 3 AEs
(>5% Patients)
VEMURAFENIB
Toxicity at 960 mg
BID dose

(n=32)

• Toxicities were
m...
Cutaneous SCC – Keratoacanthoma (KA) Subtype

Characteristics of KA subtype
• Raised button-like, central crater
• Well-di...
VEMURAFENIB cutaneous toxicity
Dabrafenib toxicity

Cutaneous
Ipilimumab and BRAF inhibitors cutaneous toxicity
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Ipilimumab and BRAF inhibitors cutaneous toxicity

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Some specific symptoms and signs of cutaneous toxicity for the new melanoma drugs

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Ipilimumab and BRAF inhibitors cutaneous toxicity

  1. 1. Squamous carcinoma low grade. Vemurafenib
  2. 2. General considerations • Surgery: – At least 2 cm margin (body) – No sentinel node for lesion less 0,75- 1 mm – Lynphadenectomy: no survival benefit shown yet; prognostic value • Radiotherapy: no major indication. Abscopal effect • Drugs: adyuvant or metastatic setting
  3. 3. Adyuvant Interferon 1 year One node with microscopic infiltration: No Interferon New drugs in the adjuvant setting in clinical trials.
  4. 4. VITILIGO after Interferon treatment
  5. 5. Flow sheet for metastatic melanoma Bad performance, pluripathology, clinical fragility: Paliative Care CNS metastasis and good general situation: Radiotherapy. Dabrafenib selected patients REST: + 1. BRAF mutation: --- Vemurafenib or Dabrafenib+trametinib Chemotherapy or Ipilimumab Patients with BRAF mutated melanoma, without clinical “agresivity” can start also with Ipilimumab
  6. 6. Summary T-cell balance APC CD-28 CTLA-4 T-cell PD-1 Tumor Kill
  7. 7. Ipilimumab dermatologi c toxicity: Pruritus, Rash, vitiligo
  8. 8. Ipilimumab “plateau”
  9. 9. Phase I Drug-Related Grade 2 and 3 AEs (>5% Patients) VEMURAFENIB Toxicity at 960 mg BID dose (n=32) • Toxicities were monitored and managed with dose interruption and/or modification Arthralgia 34% cuSCC 31% Rash 25% • No discontinuations for AEs Nausea 16% Fatigue 13% Photosensitivity 16% Palmar-plantar dysesthesia 13% Pruritis 13% Lymphopenia 6% 10
  10. 10. Cutaneous SCC – Keratoacanthoma (KA) Subtype Characteristics of KA subtype • Raised button-like, central crater • Well-differentiated neoplasm with low probability of invasion/metastasis • Can grow rapidly; may involute and regress • Typically treated by excision • Observed with other agents (e.g., sorafenib) KA in the Phase I RG7204 Trial • Occurred on sun-exposed skin • Did not result in treatment discontinuation 11
  11. 11. VEMURAFENIB cutaneous toxicity
  12. 12. Dabrafenib toxicity Cutaneous

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