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MP421 > CANCER IMMUNOTHERAPY P1 > Flashcards

CANCER IMMUNOTHERAPY P1 Flashcards

1
Q

cancer associated antigens

A
  • neoantigens
  • overexpresssed self antigens
  • self antigens that are expressed during embryonic development by are not expressed or are expressed at low levels after birth
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2
Q

neoantigens

A

result from gene mutations in cancer cells and have not been seen previously by the immune system

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3
Q

how can antigens on tumours initiate an immune response

A

cancer-associated antigens mark cancer cells as abnormal or foreign and can cause killer T cells to mount an attack against them

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4
Q

cancer cell strategies to evade detection by the immune system

A
  • many cancer associated antigens are only slightly altered versions of self antigens and difficult for the immune system to recognise
  • cancer cells may undergo genetic changes that may lead to the loss of the processing or presentation of cancer-associated antigens
  • over expression of proteins (PDL1) which suppress immune response
  • some cancer cells produce and secrete immunosuppressive cytokines (e.g. IL-10, TGF-beta)
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5
Q

tumour associated macrophages (TAM)

A
  • tumours release a range of chemokines, cytokines and growth factors to attract monocyte into the tumour stroma where they differentiate into tumour associated macrophages (TAM)
  • TAMs stimulate tumour growth, invasion, migration and metastatic spread
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6
Q

classical immunotherapy

A

the treatment of disease by inducing, enhancing or modulating an immune response

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7
Q

cancer immunotherapy

A
  • antibody-based therapy
  • vaccines
    cell based therapies>
  • dendritic cells
  • T cells
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8
Q

antibodies in cancer immunotherapy

A

exploits the expression of a specific antigen expressed by cancer cells but absent or expressed at low levels by normal cells
- to stimulate the host immune response to kill cancer cells
- to inhibit tumour growth signals
- to carry drug or a radioactive molecules to the cancer cells

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9
Q

rituximab (Rituxan)

A
  • chimeric (mouse and human) monoclonal antibody against CD20 expressed on B-lymphocytes
  • tumour cells can lose CD20 from their surface following treatment, resulting in CD20-negative tumour cells that are resistant to rituximab
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10
Q

rituximab indication

A

non-Hodgkin’s lymphoma
chronic lymphocytic leukaemia (CLL)
cancers which develops in B lymphocytes

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11
Q

side effects of rituximab

A

which can cause death and disability include:
- immune toxicity (depletion of B cells)
- CD20 is also expressed on normal B cells
- any healthy B cells destroyed by CD-20 targeted therapy can be readily replenished
- pulmonary toxicity

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12
Q

rituximab mechanism of action

A

cells death induced by:
- apoptosis
- ADCC antibody-dependent cellular cytotoxicity
- Fc arm of the antibody engages Fc receptor triggering (FcR)-positive inflammatory cells, such as natural killer cells and macrophages
- CMC complement mediated cytotoxicity

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13
Q

main side effect of herceptin

A

cardiac dysfunction

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14
Q

HER2

A

activates MAPK and PI3K pathways which increases cell growth, survival, adhesion, migration, and differentiation

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15
Q

Herceptin receptor

A

Herceptin binds to HER2 receptor

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16
Q

herceptin in HER2-overexpressing metastatic breast cancer

A
  • in combination with paclitaxel for first-line treatment
  • single agent in patients who have received one or more chemo regime
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17
Q

administration of herceptin

A

IV infusion
SC injection - early breast cancer only

breast cancer every 1 or 3 weeks up to 1 year
gastric cancer every 3 weeks

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18
Q

immune checkpoint proteins

A
  • can suppress T-cell response
  • inhibitory check point inhibitors are crucial for modulating the duration and amplitude of physiological immune responses in peripheral tissues
  • minimise collateral tissue damage
19
Q

CTLA-4

A

cytotoxic T-lymphocyte-associated protein 4-receptor

inhibitory checkpoint receptor protein expressed on T cells

20
Q

Ipilimumab

A
  • antibody against CTLA-4 expressed on T cells
  • ipilimumab blocks negative signalling from CTLA-4
21
Q

process in which ipilimumab blocks CLTA-4

A
  • antigen-presenting cell (DC or macrophages) presents a processed antigen in the context of MCHII
  • recognised by TCR on T-cell
  • for T-cell activation co-stimulatory signals from APC is needed (CD28 binds B7)
  • CTLA-4 binds B7 no T-cell to terminate activation
  • ipilimumab blocks CTLA-4
22
Q

administration of ipilimumab

A

intravenous infusion 3mg/kg every 3 weeks for 4 doses

23
Q

common side effects related to inflammatory responses

A

fatigue
diarrhoea
skin rash
vomiting

24
Q

ipilimumab indication

A
  • ipilimumab is approved for use in combination with the PD-1 inhibitor nivolumab to treat unresectable melanoma
  • advanced treatment-naive renal cell carcinoma (RCC)
  • metastatic microsatellite instability-high (MSI-h) or mismatch repair deficient (dMMR) colorectal cancer that has progressed on previous treatment
25
Q

PD-1

A

checkpoint receptor protein expressed on T cells and B cells

26
Q

PD-L1/PD-L2

A
  • PD-L1 and PD-L2 are ligands to PD1 and is expressed by dendritic cells, macrophage (APC)
  • PD-L1 is present in to cytoplasm and plasma membrane of cancer cells, but not all cancers or all cells within a cancer express PD-L1
27
Q

which cancers is PD-L1 expressed

A
  • especially in NSCLC
  • melanoma
  • renal cell carcinoma
  • gastric cancer
  • hepatocellular/cutaneous
  • various leukaemias
  • multiple myeloma
28
Q

the cancer immunity cycle blocked by PD-L1/PD1

A
  1. tumour cells produce mutated antigens that are captured by dendritic cells
  2. the dendritic cells prime T cells with tumour antigen and stimulate the activation of cytotoxic T cell
  3. activated T cells then travel to the tumour and infiltrate the tumour environment
  4. the activated T cells recognize and bind to the cancer cells
  5. the bound effector T cells release cytotoxins, which induce apoptosis in their target cancer cell
  6. the cancer cell can block the T-cell attack through PD-L1 (cancer cells) binding to PD1 on T-cell
29
Q

how do tumours use PD1-mediated immune suppression to avoid immune surveillance

A
  • PD-1 binds to PD-L1/PD-L2 which inhibit T-cell proliferation
  • some cancer cells have large amounts of PD-L1, which helps them evade immune attack
30
Q

proinflammatory molecules that induce PD-L1 expression

A

types I and II IFN-y
TNF-a
LPS
GM-CSF
VEGF
cytokines IL-10 and IL-4

  • the most potent inducer is IFN-y
  • IFN-y and TNF-a are produced by activated type 1 T cells
31
Q

regulation of PD-L1 expression by GM-CSF and VEGF

A

GM-CSF and VEGF are produced by a variety of cancer stromal cells, the tumour microenvironment upregulates PD-L1 expression, thereby, promotes immune suppression allowing tumour cells to escape immuno-surveillance

32
Q

PD-1 inhibitors

A

PROGRAMMED CELL DEATH PROTEIN 1

pembrolizumab
Nivolumab

33
Q

PDL-1

A

PROGRAMMED DEATH-LIGAND 1

atezolizumab
avelumab
durmalumab

34
Q

microsatellite instability and mismatch DNA repair

A
  • microsatellite is a set of short repeated DNA sequences in which certain DNA motifs (ranging in length from 1-6 or more base pairs) are repeated, typically 5-50 times
  • microsatellite instability results from impaired DNA mismatch pair
    -MMR corrects DNA errors that spontaneously occur during DNA replication (single base mismatches, short insertion or deletion)
  • prevent mutations
35
Q

cause of defects in MMR

A

defects in MMR are associated with genome-wide instability and increased TMB

36
Q

Pembrolizumab

A

approved for adults and paediatric pts with unresectable or metastatic solid tumours that have been identified as having a biomarker referred to as a microsatellite
instability-high (MSI-H) or mismatch repair deficit (dMMR)

37
Q

side effects of checkpoint inhibitors

A

diarrhoea
pneumonitis
rashes and itchiness
problems with some hormone levels
kidney infections

38
Q

administration of checkpoint inhibitors

A
  • intravenous infusion every 3 weeks until disease progression or up to 24 months in patients without disease progression
  • atezolizumab (PD-L1) available as subcutaneous injection, cuts treatment time from to 7 min from about 30-60 for an infusion
39
Q

chimeric antigen receptors T-cell therapy (CAR-T)

A
  • T-cells are modified to express CARs
  • CARs are genetically engineered receptors that combine the specific binding domains from a tumour targeting antibody with T-cell signalling domains to allow specifically targeted antibody redirected T-cell activation
40
Q

CAR T cell therapy - drugs that target CD-19

A

axicabtagene
ciloleucel
tisagenlecleucel

41
Q

CAR T cell therapy in children

A
  • first approved for acute lymphoblastic leukaemia paediatric and adolescent patients
  • intense chemotherapy cure 80% of all paediatric
  • effective treatments have been limited for pts whose cancers return, or relapse, after chemotherapy or a stem cell transplant
42
Q

side effects of CAR T cell therapy

A

CYTOKINE RELEASE SYNDROME
occurs when a large number white blood cells are activated and release inflammatory cytokines, which in turn activate more white blood cells
lead to systemic hyper-inflammation

also
NEUTROPENIA
NEUROTOXICITY

43
Q

HPV and cancer

A
  • HPV > sexually transmitted virus spread by vaginal, anal and oral sex
  • more than 100 types of HPV, at least 13 are cancer-causing
  • HPV DNA detected in 90-100% of cervical cancer specimens
  • HPV DNA required for development of cervical cancer
  • HPV vaccination available

MP421 (12 decks)

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