Advancements in Treatment of Malignancy Flashcards
(29 cards)
How have advancements in treatment improved prognosis of haematological malignancies?
60-70% of high grade B cell-NHL are cured
Average lifespan after diagnosis with low grade NHL is almost 20 years
What is the supportive therapy for haematological malignancy?
Prompt treatment of neutropenic fever/infection = broad spectrum antibiotics
Red cell and platelet transfusion
Growth factors
Prophylactic antibiotics and antifungals
How is chemo/radiotherapy delivery optimised?
Increase dose when needed and accept side effects
Reduce chemotherapy or miss out radiotherapy in those who don’t need it to avoid long term side effects
How are PET scans used to guide treatment of Hodgkin’s lymphoma?
Used to guide chemo/radiotherapy = relapse likely if PET positive after 2 out of 6 courses of ABVD
What are some examples of targeted therapies?
Monoclonal antibodies, biologics, molecular treatments
What are the benefits of monoclonal antibodies?
Immune treatment so only affect cells which possess target protein = avoids side effects
More effective than chemo alone when used alongside chemo
What is rituximab?
Mouse/human chimeric monoclonal antibody
What is the target of rituximab?
CD20 = murine variable region of antibody binds specifically to CD20 on B cells
What is the purpose of the human IgG1Fc domain on rituximab?
Works in synergy with human effector mechanisms
How is rituximab given?
As a 5 minute injection under the skin
What are the benefits of rituximab?
Improves survival in low grade and mantle cell NHL
FCR improves survival in CLL
RCHOP cures high grade B cell NHL
What are some examples of B cell monoclonal antibodies?
Rituximab, obinutumab, ofatumunab
What are the benefits of obinutumab and ofatumunab?
More direct kill of malignant B cells that rituximab
Better in CLL in less fit patients when used with gentle chemo
When are obinutumab and ofatumunab mainly used?
Mainly used in patients not responding to rituximab
What is brentuximab vedotin?
Anti-CD30 antibody with chemotherapy conjugated on = target’s Hodgkin’s cells and some T cell NHL
What is the action of biologics?
Don’t affect cells as they divide and cause side effects as they aren’t targeted to malignant cells
When are biologics used?
To treat multiple myeloma
What are the two most commonly used biologic therapies?
Proteosome inhibitors and IMIDs
What is the action of proteosome inhibitors?
Block breakdown of old proteins in cell causing apoptosis via the accumulation of toxic proteins
What are the uses of proteosome inhibitors?
Boretezomib has some effect in mantle cell NHL
Used in some low grade NHL
What are the side effects of proteosome inhibitors?
Nerve damage and low platelets
What is the use of IMIDs?
Treat myeloma and other plasma cell disorders
What are some examples of IMIDs?
Lenalidomide and pomalidomide have less side effects than thalidomide
What is an example of a molecular treatment of haematological malignancy?
Tyrosine kinase inhibitors = imatinib, nilotinib, bosutinib
