Cancer treatment

Question 1

what is used to detect remission in hodgkins

Answer 1

PET scan

Question 2

what are the 2 types of cytotoxic drugs

Answer 2

cell cycle specific

non-cell cycle specific

Question 3

what are cell-cycle agents good for

Answer 3

proliferating tumours

Question 4

how do cell-cycle agents work

Answer 4

PREVENTS MITOSIS AND CELL REPLICATION
antimetabolites - impair nucleotide syntheses/incorporation
mitotic spindle fibre inhibitors

Question 5

examples of antimetabolites and what they act on

Answer 5

methotrexate - inhibits dihydrofolate reductase
mercaptopurine/cytosine arabinoside/fludarabine - artificial bases incorporated into DNA
hydroxyurea - impaired deoxynucleotide synthesis

Question 6

examples of mitotic spindle inhibitors

Answer 6

vinca alkaloids

taxotere

Question 7

examples of non-cell cycle agents

Answer 7

alkylating agents (chlorambucil, melphalan)
platinum derivatives (cis-platinum, carboplatin)
cytotoxic antibiotics (anthracyclines: daunorubicin, doxorubicin)

Question 8

how do alkylating agents work

Answer 8

bind covalently to bases of DNA - induces apoptosis

Question 9

general side effects of cytotoxic drugs

Answer 9

bone marrow suppression (anaemia, bleeding, infection)
gut mucosa damage 
hair loss 
fatigue
nausea vomiting

Question 10

side effect of vinca alkaloids

Answer 10

neuropathy

infertility and secondary malignancy (long term)

Question 11

side effect of anthracyclines

Answer 11

cardiotoxicity 
cardiomyopathy (long term)

Question 12

side effect of cis-platinum

Answer 12

nephrotoxicity

Question 13

why might chemotherapy fail

Answer 13

slow tumour growth 
drug resistant mechanisms:
decreased accumulation 
increased drug metabolism 
increased DNA repair
altered gene expression

Question 14

why is CLL more difficult to treat

Answer 14

mutation of P53 gene

P53 allows cells to recognise when they have been damaged by chemo and induces apoptosis

Question 15

supportive therapy during cytotoxic therapy

Answer 15

broad spectrum antibiotics
red cell/platelet transfusions
growth factor
prophylactic antibiotics and antifungals (itraconazole or posaconazole)

Question 16

examples of targeted therapy

Answer 16

monoclonal antibodies
biologic agents
molecularly targeted treatments

Question 17

how do monoclonal antibodies work

Answer 17

only affect cells which possess target protein

antibody attaches to cell initiating complement cascade and NK cells

Question 18

when are monoclonal antibodies used

Answer 18

alongside chemotherapy

Question 19

example of monoclonal antibodies

Answer 19

rituximab

Question 20

what is rituximab used for

Answer 20

high grade NHL

improves survival and prolongs remission in CLL

Question 21

why might monoclonal antibodies not work

Answer 21

relies on immune system (NK cells and complement) to be functioning

Question 22

what is brentuximab vedotin

Answer 22

monoclonal antibody and chemotherapy combines

used in hodgkins and some T cell NHL

Question 23

examples of biological treatments

Answer 23

protosome inhibitors

IMIDs

Question 24

what are biologics used in

Answer 24

multiple myeloma

Question 25

how do protosome inhibitors work

Answer 25

causes build up toxic proteins in cells initiating apoaptosis

Question 26

what are IMIDs

Answer 26

derivatives of thalidomide | orevent tumours from evading the immune system

Question 27

when are IMIDs used

Answer 27

remission of low grade NHL and CLL

Question 28

examples of molecular treatments

Answer 28

tyrosine kinase inhibitors | ibrutinib - targets malignant B cells

Question 29

when are tyrosine kinase inhibitors used

Answer 29

acute and chronic myeloid leukaemia

Question 30

examples of tyrosine kinase inhibitors

Answer 30

imatinib nilotinib dasatinib ponatinib

Question 31

side effects of tyrosine kinase inhibitors

Answer 31

diarrhoea fluid in lungs neutropenia

Question 32

side effects of B cell drugs (ibrutinib)

Answer 32

``` diarrhoea rash fatigue liver abnormality fever ```

Question 33

what are checkpoint inhibitors

Answer 33

nivolumab | prevents immune evasion

Question 34

when is nivolumab used

Answer 34

malignant melanoma | lymphoma relapses

Question 35

what is immune therapy

Answer 35

bone marrow transplant - T cells from donor cause immune attack on cancer

Question 36

adverse effect of bone marrow tansplant

Answer 36

also attacks normal host cells

Question 37

what is adoptive immunotherapy

Answer 37

makes patients own immune cells recognise the cancer as foreign CART therapy

Question 38

when is adoptive immunotherapy used

Answer 38

ALL | NHL