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Oncology + Palliative > Biological Therapy > Flashcards

Flashcards in Biological Therapy Deck (28):
1

What are the 4 concepts of immunotherapy?

Boosts body's natural defences to fight cancer

Stops/ slows growth of cancer cells

Stops cancer spreading

Helps immune system work better at destroying cancer cells

2

6 types of immunotherapy

Monoclonal antibodies (-mab)

Tyrosine kinase inhibitors (-mib)

Non-specific immunotherapies

Oncolytic virus therapy

T cell therapy

Cancer vaccines

3

How do monoclonal antibodies work?

Targeted therapy to block abnormal protein in cancer cell (biological therapy)

Attach to specific proteins on cancer cells.

Flags cells so immune system can destroy them

4

What are immune checkpoints + name the 2 important ones?

PD-1/PD-L1 and CTLA-4 pathways

Critical to immune system's ability to control cancer growth

5

How do tyrosine kinase inhibitors work?

Tyrosine kinase = enzymes that activate proteins by signal transduction cascades

Activated by phosphorylation

TKIs inhibit this

6

SE of monoclonal antibody treatment + management

Fatigue, diarrhoea, colitis, skin rash, transaminitis, glomerulonephritis

Pneumonitis Hypo/hyperthyroidism

Immune side effects mimic infection

Managed with steroids

7

What are non-specific immunotherapies, what are the SE of each?

Interferons + interleukins

Interferons = slow growth of cancer cells.

SE: flu like S+S, increased risk of infection, rashes + thinning hair

Interleukins = treats kidney + skin cancer.

SE: weight gain, low BP, flu-like S+S

8

How does trastuzamab work + how is it administered?

IV infusion

Monoclonal antibody to protein called human epidermal growth factor receptor 2 (HER2)

Work against HER2 positive cancers

Trastuzumab blocks HER2 receptor

9

Indications for trastuzumab

HER2 positive breast cancer

10

SE of trastuzumab

Acne, alopecia, angioedema, bone pain, bone marrow suppression, cardiotoxic, dry eyes + skin

11

Interactions of trastuzumab

Alteplase + anticoagulants = increased risk of bleeding

Glucose = risk of bleeding

12

Action of tamoxifen

Reduces oestrogen activity - used in ER or PR+ disease

Used for 5 years post-op

Selective oestrogen receptor modulator 

Antagonist in breast and agonist in bone + uterus

13

Serious + common SE of tamoxifen

Serious = increased risk of uterine cancer, stroke, vision problems + pulmonary embolism

Common = irregular periods, weight loss, hot flushes, mood changes, vaginal discharge, endometrial changes

14

Action of Letrozole/ Anastrazole

Nonsteroidal aromatase inhibitor for treatment of hormonally responsive breast cancer post surgery

Letrozole only effect in post-menopause (when oestrogen is predominantly in peripheral tissue)

Inhibits conversion of androgens to oestrogens

15

Indications for Letrozole/ Anastrazole

Adjuvant treatment of oestrogen receptor positive early breast cancer in postmenopausal women (can be used after tamoxifen)

16

Contraindications for Letrozole/ Anastrazole

Pre-menopausal women

Susceptibility to osteoporosis

17

SE of Letrozole/ Anastrazole

Anorexia, cutaneous vasculitis, drowsiness, hair thinning, vasomotor, Steven johnsons

18

What SE do you get from drugs targeting EGFR pathway?

Acneiform rash

Diarrhoea 

19

Which cancers are most hormone sensitive?

Prostate, breast, endometrium, lymphocytic malignancies (lymphoma, myeloma, leukaemia)

20

What is the mechanism between steroid hormones + tumours?

Steroids interact with cytoplasmic protein receptors to form functional DNA transcription factors

Altering this interaction = hormone therapy

Also, presence of cytoplasmic steroid receptors on tumour cells predict hormone sensitivity (eg ER+ in breast ca)

21

What is medical castration in women?

Using long acting LHRH analogues (goserelin, leuprorelin) which, by receptor down regulation in pituitary, block LH + FSH production + block gonadal hormone output

Only suitable in pre-menopausal women

22

How do aromatase inhibitors work?

Inhibit aromatisation of adrostenedione to oestrone in fat + liver of postmenopausal women

Reduces oestrogen synthesis

23

Examples of aromatase inhibitors

Anastrozole, exemestane, letrozole

24

Types of anti-androgen, their effect in the body and uses in cancer

Steroidal (cyproterone acetate) = inhibits androgen receptor + substitutes for testosterone in hypothalamus, stimulating negative feedback inhibition to reduce LHRH release

Non steroidal (bicalutamide) = inhibits testosterone in tumour cells + hypothalamus, losing feedback + causing testosterone to rise.

Combine with LHRH analogue to prevent this effect = used in prostate cancer

25

How are glucocorticoids used in cancer therapy?

Induce apoptosis in malignant lymphoid cells - treat leukaemias, lymphomas, myelomas + Hogdkins disease

26

When is hormone supplementation used + give examples?

In sex hormone sensitive cancers:

Oestrogen given to down regulate hypothalamic LHRH in prostate cancer

Tachyphylaxis of receptors - use high dose oestrogens in breast cancer

27

When are progestogens used?

Given orally in high doses for progesterone sensitive cancers (breast + endometrium)

Inhibit tumour growth (act as agonist of progesterone receptor)

Also stimulate appetite - useful in palliation

28

SE of immunotherapy

Fatigue

Gut: diarrhoea, colitis

Skin: rash, itch

Liver: transaminitis

Renal: glomerulonephritis

Lung: pneumonitis

Endocrine: low/high thyroid, hypophysitis (pituitary)