10 immunotherapy

Question 1

Name two prophylactic cancer vaccines

Answer 1

HPV vaccine, HBV vaccine.

Question 2

How does the HPV vaccine work?

Answer 2

Contains recombinant virus-like particles with L1 capsid antigen, inducing strong neutralising antibody response.

Question 3

Name the first FDA-approved cancer treatment vaccine.

Answer 3

Sipuleucel-T (Provenge®) for metastatic prostate cancer.

Question 4

How is the BCG vaccine used in cancer therapy?

Answer 4

Used to treat bladder cancer by inducing necrosis and cytokine release.

Question 5

What is an adjuvant?

Answer 5

A substance that enhances the body’s immune response to an antigen.

Question 6

Name an example of an adjuvant used in vaccines.

Answer 6

Aluminium salts (Alum).

Question 7

Why are adjuvants necessary in some vaccines?

Answer 7

To enhance immune response, especially in non-live vaccines.

Question 8

What is desensitisation used for?

Answer 8

Treating allergies through controlled exposure to allergens.

Question 9

What immunological shift does desensitisation cause?

Answer 9

Switch from IgE to IgG4, promoting Treg response.

Question 10

What are possible side effects of desensitisation?

Answer 10

Anaphylaxis, local reactions.

Question 11

Name a cytokine used in therapy and its function.

Answer 11

G-CSF; stimulates neutrophil production.

Question 12

What does Pembrolizumab (Keytruda) target?

Answer 12

PD-1 receptor on T cells.

Question 13

How does Pembrolizumab work?

Answer 13

Blocks PD-1 to reactivate T cells against tumour cells expressing PD-L1.

Question 14

Name a monoclonal antibody used for kidney transplant rejection.

Answer 14

Basiliximab (CD25 targeting IL-2 receptor alpha).

Question 15

What is the function of TNF-alpha?

Answer 15

Pro-inflammatory cytokine involved in immune responses.

Question 16

How can TNF-alpha be inhibited?

Answer 16

Using infliximab (TNF-alpha inhibitor), useful in RA and Crohn’s disease.

Question 17

What is IVIG therapy?

Answer 17

Intravenous immunoglobulin therapy; provides passive immunity in antibody-deficient individuals.

Question 18

What type of immunoglobulin is used in IVIG?

Answer 18

IgG only.

Question 19

What is HSCT and what is it used for?

Answer 19

Haematopoietic stem cell transplantation, used for SCID, leukaemia, and metabolic disorders.

Question 20

What are the sources of HSCT?

Answer 20

Peripheral blood, bone marrow, foetal cord blood.

Question 21

What is the difference between autologous and allogeneic HSCT?

Answer 21

Autologous: patient’s own cells; Allogeneic: donor cells.

Question 22

What is gene therapy?

Answer 22

Replacement of defective genes with normal genes in stem cells.

Question 23

What is the mechanism of ADA-SCID gene therapy?

Answer 23

Introduces functional ADA enzyme to allow lymphocyte development.

Question 24

What strains of HPV are in Gardasil?

Answer 24

HPV 6, 11, 16, 18.

Question 25

What immune response protects against HPV?

Answer 25

Neutralising antibodies.

Question 26

Which vaccine treats bladder cancer?

Answer 26

BCG vaccine.

Question 27

Define an adjuvant.

Answer 27

Enhances immune response to antigen.

Question 28

What is in Freund’s complete adjuvant, and is it licensed in humans?

Answer 28

Includes BCG, banned due to toxicity.

Question 29

How do adjuvants work?

Answer 29

Activate innate immunity, enhance adaptive response.

Question 30

What does OKT3 bind to and its effect?

Answer 30

CD3, depletes T cells.

Question 31

When is OKT3 used clinically?

Answer 31

Acute transplant rejection.

Question 32

What is the target of Basiliximab?

Answer 32

CD25, IL-2 receptor alpha.

Question 33

What does TNF-alpha do?

Answer 33

Mediates inflammation.

Question 34

How can TNF-alpha effects be reduced?

Answer 34

Anti-TNF drugs like infliximab.

Question 35

How does Keytruda work?

Answer 35

Blocks PD-1 to enhance T cell response against cancer.

Question 36

What is the function of T regulatory cells in desensitisation?

Answer 36

Suppress excessive immune responses.

Question 37

What are the limitations of prophylactic cancer vaccines?

Answer 37

Limited efficacy against established tumours. Mainly effective in preventing tumour development. Requires identification of tumour-specific antigens.

Question 38

How do tumour-specific antigens help in cancer vaccines?

Answer 38

They are unique to tumour cells. Can be viral-derived (e.g., HPV, HBV). Stimulate immune responses targeting cancer cells.

Question 39

How does BCG therapy work for bladder cancer?

Answer 39

Induces necrosis in tumour cells. Triggers cytokine release (IL-1, IL-6, TNF-α). Activates CD8+ T cells via tumour antigen presentation.

Question 40

What is MF-59 and how does it work?

Answer 40

A squalene-based adjuvant used in Europe. Enhances antigen uptake by APCs. Promotes a strong immune response.

Question 41

Why are regulatory T cells (Tregs) important in desensitisation?

Answer 41

Suppress allergic inflammation. Modulate immune response to allergens. Express CD25+ and produce IL-10, TGF-β.

Question 42

What is the role of IL-21 in immune response?

Answer 42

Produced by T follicular helper (Tfh) cells. Essential for B cell activation and antibody production. Enhances CD8+ T cell responses.

Question 43

Why is TGF-β important in immune regulation?

Answer 43

Suppresses excessive immune activation. Essential for Treg function. Involved in wound healing and tissue repair.

Question 44

What are the risks of monoclonal antibody therapy?

Answer 44

Immune-related adverse effects (e.g., autoimmunity). Infusion reactions (fever, chills, anaphylaxis). Opportunistic infections due to immune suppression.

Question 45

What are the advantages of autologous HSCT over allogeneic HSCT?

Answer 45

Lower risk of graft-versus-host disease (GvHD). No need for a matched donor. Reduced risk of immune rejection.

Question 46

Why do allogeneic HSCT patients need immunosuppression?

Answer 46

Prevents rejection of donor cells. Minimises graft-versus-host disease (GvHD). Requires careful monitoring for infections.

Question 47

How does Strimvelis treat ADA-SCID?

Answer 47

Uses a retroviral vector to insert a functional ADA gene. Modified stem cells reinfused into the patient. Restores lymphocyte development and function.