Rational treatment of cancers Flashcards
What are the 4 rational cancer strategies:
- Induce differentiation
- Discourage proliferative signalling
- Promote apoptosis
- Exploit checkpoint vulnerability
- Identify the relevant population for specific strategy
Why is cancer incidence falling in large?
- Storing food better
2. Increased screening of cervical and colorectal cancers
Why has detection improved since the 70s?
Encouraging people to look for breast cancer
MRIs increasingly detect smaller growths
What are the types of tumours and which one do we want to target?
Indolent tumours
Aggressive tumours
Intermediate tumours - (potential to disseminate- but can be treated before dissemination and metastases form)
-we want to target aggressive and intermediate tumours
How do we establish if a tumour is aggressive or indolent?
Age size of tumour number of lymph nodes in the vicinity that have been affected histology pathological grade receptor status
What % of people with breast and prostate cancer shouldn’t be treated?
80%
What test helps identify who really needs treatment?
EXPRESSION ARRAY- analysis of gene expression in cancer patients
By using bioinformatics- distinguished 70 distinct ‘prognosis’
prognosis gene expression could then be used to stratify the breast cancer patients
see if these prognosis genes are upregulated or downregulated
by collating this data- it is clear that patients have different profiles
some have a ‘good signature’- low level of metastases - high chance of survival
use this data to make a spectrum- people with a good signature don’t need treatment
How can differentiation stop (one form of) acute promyelocytic leukaemia?
Switch off the transcriptional repressor with retinoic acid
proliferation pathway undertaken by the promyelocytes is switched off
blast cells can be induced to differentiate into neutrophils by treatment with all-trans retinoic acid
treatment with ATRA and concomitant chemotherapy often results in complete remissions
How does the pathway do awry in promyelocytic leukaemia?
Predictable chromosomal rearrangement- translocation involving chromosomes 15 and 17
RA receptor gene breaks off- translocates- fusion with PML gene
RA no longer recognised
What organelle is coded for by PML and how does it change in cancer?
PML bodies= nuclear organelle, usually sits in the nucleus
in leukaemia- RA is fused to the PML bodies
Which 2 compounds can treat acute promyelocytic leukaemia?
All-trans retinoic acid (RA derivative)
Arsenic trioxide
How does arsenic trioxide work?
ARO3 promotes ubiquitin ligase to specifically target the PML fusion protein- drives it to the proteasome
All-trans retinoic acid mechanism is essentially the same
How can we exploit checkpoint vulnerability in cancer cells?
In hepatoma cells- treat them with doxorubicin- DNA damaging drug that normally induces G2 arrest-
mitotic catastrophe= fragmented nuclei
cancer cells killed
Why is it difficult to target tumour suppressor genes in cancer cells?
LOH is a traditional phenotype in cancer cells- theyve lost both copies of the TSG- its not there
running out of enzymatic targets in terms of inhibiting things
we want a GOF in tumour suppressor genes, instead of inhibiting
Why can we exploit checkpoint vulnerability in cancer cells but not WT cells?
WT cells- induce DNA damage-checkpoint ensure that there is a cell cycle delay- waiting for repair/stress to be removed- if you block cells in s phase- all replication forks stop-
there is no delay/stop in cancer cells- they will attempt DNA replication, and will complete G2 even if there is no replicated DNA- this leads to mitotic catastrophe= CELL DEATH
