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Flashcards in Biological Therapy Deck (28):

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


6 types of immunotherapy

Monoclonal antibodies (-mab)

Tyrosine kinase inhibitors (-mib)

Non-specific immunotherapies

Oncolytic virus therapy

T cell therapy

Cancer vaccines


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


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


How do tyrosine kinase inhibitors work?

Tyrosine kinase = enzymes that activate proteins by signal transduction cascades

Activated by phosphorylation

TKIs inhibit this


SE of monoclonal antibody treatment + management

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

Pneumonitis Hypo/hyperthyroidism

Immune side effects mimic infection

Managed with steroids


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


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


Indications for trastuzumab

HER2 positive breast cancer


SE of trastuzumab

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


Interactions of trastuzumab

Alteplase + anticoagulants = increased risk of bleeding

Glucose = risk of bleeding


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


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


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


Indications for Letrozole/ Anastrazole

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


Contraindications for Letrozole/ Anastrazole

Pre-menopausal women

Susceptibility to osteoporosis


SE of Letrozole/ Anastrazole

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


What SE do you get from drugs targeting EGFR pathway?

Acneiform rash



Which cancers are most hormone sensitive?

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


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)


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


How do aromatase inhibitors work?

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

Reduces oestrogen synthesis


Examples of aromatase inhibitors

Anastrozole, exemestane, letrozole


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


How are glucocorticoids used in cancer therapy?

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


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


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


SE of immunotherapy


Gut: diarrhoea, colitis

Skin: rash, itch

Liver: transaminitis

Renal: glomerulonephritis

Lung: pneumonitis

Endocrine: low/high thyroid, hypophysitis (pituitary)