Cancer Immunology

Question 1

two ways that cancer evades immune system

Answer 1

guards vs. cloak

Question 2

cloak methods

Answer 2

intrinsic factors- antigen loss of MHC loss, secrete immunosppressive cytokines (IL-10); EXPRESSION OF PDL-1 THAT ALTER T CELL FUNCTION

Question 3

guards

Answer 3

extrinsic factors- geographic barriers and suppressing suppressors or regulatory immune cells (TAMs and MDSCs)

Question 4

3 ways to drive the immune response

Answer 4

1. T cell receptor interacting with MHC 2. CD28:B7 3. CTLA-4: B7 and PD1: PDL1

Question 5

how do we upregulate the first one (the t cell receptor interacting with MHC)

Answer 5

CAR therapies, vaccines, adoptive T cell therapies

Question 6

how do we upregulate the CD28:B7?

Answer 6

agonist antibodies

Question 7

how do we upregulate ctla-4 and PD1?

Answer 7

checkpoint blockade

Question 8

toxicity profile for ipi

Answer 8

common: colitis and rash which we can stop with high dose steroids
infrequent: hepatitis and hypophysitis (decrease in size of pituitary) and these are untreatable

Question 9

kinetics of ipi

Answer 9

gets worse before it gets better
normally scan at week 18
alot of heterogeneity with response

Question 10

toxicity profiles for pd1 blocker

Answer 10

pneumonitis is more common; diarrhea and rash much less compared to ipi

Question 11

abscopal effect (unexpected benefit)

Answer 11

being on combined immunotherapy, if you radiate 1 tumor, you get a systemic response to radiation even in areas not radiated

Question 12

unexpected toxicity

Answer 12

hepatotoxicity when you combine ipi with some other drug