Cancer management Flashcards

Question

WHO/ECOG performance: Functional status

Answer 1

- Grade 0: Fully active, able to carry on all pre-disease performance without restriction - Grade 1: Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature - Grade 2: Ambulatory and capable of all self care but unable to carry out any work activities, up and about more than 50% of waking hours - Grade 3: Capable of only limited self-care, confined to bed or chair more than 50% of waking hours - Grade 4: Completely disabled, cannot carry on any self care, totally confined to bed or chair - Grade 5: Deceased

Answer 2

- Previous contract reaction ? - Renal function (if GFR <40ml/min then increased risk of contrast induced AKI) - Diabetes mellitus - metformin therapy

Answer 3

- Stage of disease - Fitness or performance status - Co-morbidities - Histology - Other characteristics of tumour - Preferences for treatment - Social support network

Answer 4

Immune checkpoint inhibitors are a type of immunotherapy that are increasingly being used to treat certain types of cancer, as an alternative to cytotoxic chemotherapy. In contrast to therapies such as chemotherapy and tumour-targeted drugs that directly affect the growth and proliferation of tumour cells, these targeted treatments harness the body’s natural anti-cancer immune response. They boost its ability to attack and destroy the cancer cells.

Answer 5

T-cells are an important part of our immune system which help destroy cancer cells. Some cancer cells make high levels of proteins that turn T-cells off. Checkpoint inhibitors block this process and reactivate and increase the body’s own T-cell population, enhancing the immune systems own ability to recognise and fight cancer cells.

Answer 6

- Ipilimumab (Yervoy) - Nivolumab (Opdivo) and pembrolizumab (Keytruda) - Atezolizumab, Avelumab and Durvalumab

Answer 7

Ipilimumab (Yervoy) is a checkpoint inhibitor that blocks CTLA-4 (cytotoxic T lymphocyte-associated protein 4). It is a treatment for advanced melanoma. CTLA-4 is found on T-cells.

Answer 8

Nivolumab (Opdivo) and pembrolizumab (Keytruda) blocks PD-1 (programmed cell death protein 1). These are treatments for melanoma, Hodgkin's lymphoma, non-small cell lung cancer and urological cancers. PD-1 are found on T-cells and cancer cells.

Answer 9

Atezolizumab, Avelumab and Durvalumab block PD-L1 and is used to treat lung cancer and urothelial cancer. It is also undergoing trials as a treatment for breast cancer.

Answer 10

All CTLA-4 inhibitors and PD-1/PD-L1 inhibitors currently available are monoclonal antibodies (laboratory-produced molecules engineered to serve as substitute antibodies that each bind to a specific protein). They are all administered by injection/intravenous infusion. Mostly, they are given as a single-agent treatment but sometimes, they can be combined with chemotherapy or each other. For example, ipilimumab and nivolumab can be used in combination.

Answer 11

This mechanism of action of these drugs can result in side effects termed 'Immune-related adverse events' that are inflammatory and autoimmune in nature. This is because all immune cells are boosted by these drugs, not just the ones that target cancer. The over-active T-cells can produce side effects such as: - Dry, itchy skin and rashes (most commonly) - Nausea and vomiting - Decreased appetite - Diarrhoea - Tiredness and fatigue - Shortness of breath and a dry cough. Management of such side effects reflects the inflammatory nature, often involving corticosteroids. It is important to monitor liver, kidney and thyroid function as these drugs can affect these organs.