OnCo

Sign in to keep your watchlist

Your watched pages live in this browser. Sign in with an email link and OnCo keeps the same list on every device you use. Only your email address and your watchlist are stored.

Living with cancer· Appointment prep

Appointment sheet: Advanced melanoma (unresectable stage III and stage IV)

One page to bring and write on: your details, the questions for Advanced melanoma (unresectable stage III and stage IV) plus your own, the words you may hear, what to bring, the treatments the standard of care names, and room for the answers and agreed next steps. What you type stays in this browser. Print it or save it as a PDF. New to all this? Start with the first 60 days. Orientation, not medical advice.

Tick the questions to print

All of this cancer's questions start ticked. Untick what does not apply; ticks are kept in this browser. .

Your own questions

Shared with the prep pack, so questions you add there appear here too.

Print or save as PDF

Use (or Ctrl+P, Cmd+P on a Mac). To keep a copy, choose Save as PDF as the destination in the print dialog. Only the sheet prints; the controls stay on screen. Your typed notes print where you typed them; empty fields print as ruled lines to write on.

Appointment sheet

Advanced melanoma (unresectable stage III and stage IV)

Prepared with OnCo (onco.cc/prep/advanced-melanoma/). Orientation, not medical advice; your team knows your case.

My details

Name
Date of appointment
Hospital and clinician
Who is coming with me

What I know, what is unclear, changes to discuss

Saved in this browser
What I know so far
What is unclear to me
Changes since last time

My questions

24 on the sheet
Newly diagnosed
  1. 1.What is my exact diagnosis, stage, and grade, and which tests established them?
  2. 2.Which biomarkers have been tested on my tumour (for example BRAF V600 mutation, Lactate dehydrogenase, PD-L1 expression, Tumour mutational burden and interferon-gamma signature, NRAS and KIT mutations), and what were the results?
  3. 3.Which subtype is my cancer, and does that change the recommended treatment?
  4. 4.Is germline (inherited) genetic testing recommended for me or my family?
First line, fit patient
  1. 5.For my situation (first line, fit patient), which of the standard options do you recommend and why?
  2. 6.Am I a candidate for Nivolumab, Ipilimumab, Relatlimab + nivolumab or related drugs, and what side effects should I expect?
  3. 7.How do the results of CheckMate 067 and RELATIVITY-047 apply to someone like me?
BRAF V600-mutant, after immunotherapy or when rapid control is needed
  1. 8.For my situation (braf v600-mutant, after immunotherapy or when rapid control is needed), which of the standard options do you recommend and why?
  2. 9.Am I a candidate for Dabrafenib + trametinib, Encorafenib, Binimetinib, and what side effects should I expect?
  3. 10.How do the results of COLUMBUS and COMBI-d apply to someone like me?
Brain metastases
  1. 11.For my situation (brain metastases), which of the standard options do you recommend and why?
  2. 12.Am I a candidate for Nivolumab, Ipilimumab, and what side effects should I expect?
  3. 13.How do the results of CheckMate 204 apply to someone like me?
After PD-1 failure
  1. 14.For my situation (after pd-1 failure), which of the standard options do you recommend and why?
  2. 15.Am I a candidate for Lifileucel, Vusolimogene oderparepvec, Ipilimumab or related drugs, and what side effects should I expect?
  3. 16.How do the results of C-144-01 apply to someone like me?
Treatment duration
  1. 17.For my situation (treatment duration), which of the standard options do you recommend and why?
  2. 18.How do the results of KEYNOTE-006 apply to someone like me?
Oligometastatic disease
  1. 19.For my situation (oligometastatic disease), which of the standard options do you recommend and why?
Any stage
  1. 20.Are there clinical trials I could join, for example of Fianlimab + cemiplimab phase 3 (first-line melanoma), Fianlimab, PRISM-MEL-301, Brenetafusp?
  2. 21.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
  3. 22.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
  4. 23.I read that “About four in ten patients never respond to PD-1 blockade and no biomarker reliably identifies them”. How does that affect my plan?
  5. 24.I read that “Who needs the ipilimumab component and its toxicity, and whether relatlimab can replace it, has not been settled”. How does that affect my plan?

The words I may hear

  • Fixed-duration vs continuous therapy: Whether a drug is taken for a set period (say 12 months) and then stopped even though it is still working, or continued indefinitely until it fails.
  • Immune-related adverse events (irAEs): Immune-related adverse events (irAEs) are the autoimmune side effects of checkpoint inhibitors: colitis, thyroid problems, rash, hepatitis, pneumonitis.
  • Brain metastases (intracranial disease): Tumour deposits that have travelled to the brain from a cancer elsewhere, ten times more common than cancers that start in the brain, mostly from lung, breast, melanoma and kidney cancer.

Tests and results to bring

Biomarker results to ask for: BRAF V600 mutation (decides the targeted-therapy option), Lactate dehydrogenase (prognostic and part of staging), PD-L1 expression (weakly predictive; not used to withhold therapy), Tumour mutational burden and interferon-gamma signature (exploratory), NRAS and KIT mutations (trial eligibility, imatinib in KIT-mutant disease), HLA-A*02:01 (tebentafusp eligibility in uveal melanoma only).

Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.

The treatments I may be offered

From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.

Answers and next steps

Saved in this browser
What I was told
Agreed next steps, dates and who to call