patients with new signals at 5 years

agents that increase gastric pH, when of dabrafenib on other medicinal concomitant use with medicinal products sensitive substrates of certain metabolising transporters, if monitoring for efficacy adjustment is not possible. Please refer to SPC for groups of medicinal products affected. A drug utilisation review (DUR) is initiating dabrafenib treatment. Exercise co-administering with warfarin and additional INR (lnternational Normalised Ratio) Exercise caution when co-administering with additional monitoring is recommended. dabrafenib on substance transport systems: OATP1B1 and OATP1B3. Monitoring of drugs that are sensitive substrates OATP1B1 and OATP1B3 and known to have therapeutic index with regards to high peak (Cmax). Pregnancy & Lactation: potential use effective methods of contraception and for at least 16 weeks after stopping Tafinlar may decrease the efficacy of oral or hormonal contraceptives; use an effective method of contraception. exercised by considering the expected mother against possible risk to the Breast-feeding: benefit of breastfeeding for the child of therapy for the woman. impair human fertility. Tafinlar represents for impaired spermatogenesis, which irreversible. and Use Machines: minor influence. Patients should be the potential for fatigue, dizziness problems. reactions with Mekinist monotherapy melanoma: haemorrhage, cough; dyspnoea, diarrhoea, vomiting, constipation, abdominal pain, dry dermatitis acneiform, dry skin, pruritus, oedema peripheral, pyrexia, asparate increased. paronychia; cellulitis; rash pustular; anaemia; dehydration; vision blurred; periorbital impairment; left ventricular dysfunction; decreased; bradycardia; lymphoedema; stomatitis; erythema; palmar-plantar erythrodysaesthesia syndrome; skin fissures; skin chapped; mucosal inflammation; asthenia; alanine increased; blood alkaline phosphatase medications include; ipilimumab, nivolumab, and pembrolizumab. Approximately 40-to-50 per cent of people with melanoma have gene mutations. Targeted treatments, such as vemurafenib, dabrafenib and trametinib can be used to specifically target these gene mutations to help slow or stop the cancer cells growing.

In 2019 the HSE approved reimbursement for encorafenib in combination with binimetinib for the treatment of adults with unresectable or metastatic melanoma with a mutation known as BRAF V600. Just over 1,000 patients in Ireland have melanoma, of whom about half have the BRAF mutation. More than 97 per cent of BRAF mutations are in the BRAF V600 gene.

In February this year (2021), after a long advocacy campaign by cancer patients, the HSE also announced that it was to reimburse adjuvant immunotherapies for stage III melanoma patients in Ireland.

While the HSE had been reimbursing three different kinds of immunotherapy drugs for melanoma patients previously, it was only for those who were at a more advanced stage. Instead, stage III patients were continually monitored through a ‘watch and wait’ strategy, though patients with certain private health insurance plans could access these drugs.

However, the HSE now reimburses nivolumab, which is used as monotherapy for the adjuvant treatment of adults with melanoma, whose cancer involves lymph nodes or metastatic disease, who have undergone complete resection.

Pembrolizumab is also in the process of being approved for reimbursement in this cohort. This can be used as monotherapy for the adjuvant treatment of adults with stage III melanoma and lymph node involvement, who have undergone complete resection also.

Survival and prevention

Survival from melanoma has increased in Ireland since the 1990s due largely to improvements in treatment for late stage tumours, as well as more patients presenting with earlier stage disease.12 The National Cancer Strategy 2017-2026 outlines the HSE’s plans for cancer prevention and control and prioritises the development of a national skin cancer prevention plan targeting children, outdoor workers, sunbed users and those who pursue outdoor leisure activities.12 Addressing the rising incidence of skin cancer, the strategy prioritised the need to develop and implement the national skin cancer prevention plan (2019-2022).15

Melanoma is not always preventable, but a number of measures can be taken to reduce its occurrence. It is important that people are made aware of the dangers of UV radiation from the sun and artificial sources such as sunbeds. Wearing sunscreen is important and recommended even in winter, using a broad-spectrum, high UVA protection water resistant (UVA/UVB)

References

1. SCF (2020) Melanoma Overview. Skin Cancer Foundation. Available at: www.skincancer.org/skin-cancerinformation/melanoma/

2. HSE (2019) Overview Skin Cancer (Melanoma). Health Service Executive. Available at: www.hse.ie/conditions/ melanoma-skin-cancer/skin-cancermelanoma-overview.html

3. WHO (2014) World Cancer Report 2014 Chapter 5.14. World Health Organisation. ISBN 978-9283204299

4. CDC (2020) What are the symptoms of skin cancer? Centre for Disease Control and Prevention. Available at: www.cdc.gov/cancer/skin/basic_info/ symptoms.htm

5. NIH (2020) Moles to Melanoma: Recognising the ABCDE Features. National Cancer Institute. Division of Cancer Epidemiology and Genetics. Available at: https://moles-melanomatool.cancer.gov/

6. Rasterelli M, Tropea S, Rossi C, Alaibac M (2014). Melanoma: Epidemiology, Risk Factors, Pathogenesis, Diagnosis and Classification. In vivo: International Journal of Experimental and Clinical Pathophysiology and Drug Research. Available at: http://iv.iiarjournals. org/content/28/6/1005.long?utm_ medium=email&utm_source=transaction

7. ISF (2020) Skin Cancer. Irish Skin Foundation. Available at: https:// irishskin.ie/melanoma-skin-cancer/

8. Mayo Clinic (2020) Sentinel Node Biopsy. Available at: www.mayoclinic.org/testsprocedures/sentinel-node-biopsy/about/ pac-20385264#:~:text=Sentinel%20 sunscreen with a sun protection factor (SPF) of at least 30+ for adults and 50+ for children. It is advisable to seek shade and cover the skin as much as possible when in the sun, protect the face, ears and neck with a wide brimmed hat and wear sunglasses. Babies and young children are particularly vulnerable to sun exposure, and should always be kept out of direct sunlight.7 node%20biopsy%20is%20a,into%20 which%20a%20tumor%20drains

Educating people to regularly check their skin and seek help for notable changes can help lead to an early diagnosis of melanoma and increase the chances of successful treatment.2 Timely recognition, detection, rapid treatment and follow-up is key to improved outcomes and survival rates from malignant melanoma.

9. Cancer Research UK (2020) Melanoma Skin Cancer: Stages and Types. Available at: www.cancerresearchuk. org/about-cancer/melanoma/stagestypes

10. MacMillan Cancer Support (2020) Cancer Information and Support Melanoma. Available at: www.macmillan.org. uk/cancer-information-and-support/ melanoma

11. Domingues B, Lopes J, Soares P, Pópulo H (2018). Melanoma treatment in review. Immunotargets Ther. 2018; 7: 35-49. doi: 10.2147/ITT.S134842

12. NCRI (2017) Incidence of melanoma in Ireland on the rise, particularly in men. National Cancer Registry Ireland.

13. Irish Cancer Society (2020) Melanoma. Available at: www.cancer.ie/cancerinformation-and-support/cancer-types/ skin-cancer/melanoma

14. Irish Cancer Society (2020) Cancer Statistics. Available at: www.cancer. ie/cancer-information-and-support/ cancer-information/about-cancer/ cancer-statistics

15. DOH (2019) National Skin Cancer Prevention Plan 2019 – 2022. Department of Health, Ireland. Available at: www.gov.ie/en/publication/4655d6national-skin-cancer-prevention-plan2019-2022/?referrer=www.health.gov.ie/ blog/publications/national-skin-cancerprevention-plan-2019-2022/