Cancer Pharm: Immune checkpoint inhibitors + Clinical Application Flashcards
What are the 2 immune checkpoint inhibitors that are PD-1 inhibitors?
Nivolumab and Pembrolizumab
What are the 3 immune checkpoint inhibitors which are PD-L1 inhibitors?
Atezolizumab + Avelumab + Durvalumab
What is the basis for using PD-1 and PD-L1 inhibitors?
- PD-1 is a receptor on T cells
- Tumors express PD-L1; when activated T-cell binds to this receptor it becomes inactivated
What are 4 mechanisms of resistance to immune checkpoint inhibitors (PD-1 and PD-L1)?
- Primary or acquired
- Insufficienct generation of anti-tumor T-cells
- Inadequate function of tumor specific T-cells
- Impaired formation of T cell memory
What are some common and serious AE’s associated with the immune checkpoint inhibitors?
- Fatigue + nausea + loss of apetite + itching
- Serious = immune system attacks normal organs i.e., lungs, intestines, liver, kidneys
Discovery and use of which drug dramatically increased the length of survival in ALL?
Methotrexate
List 4 drugs other than methotrexate which are active against ALL; which 2 drug combo is added to one of these drugs to induce remission?
- 6-mercaptopurine, Cyclophosphamide, Vincristine and Daunorubicin
- Combo of Vincristine + Prednisone + one of the agents from above is used to induce remission
Prednisone is added to anti-tumor regimens due to what 4 effects?
- Inhibits cytokine production
- Alteration of oncogene production
- Cell cycle arrest
- Apoptosis
Which drug/route of administration is used as a prophylactic measure to prevent CNS leukemia in ALL?
Intrathecal methotrexate
What is the most active agent against AML; best used in combo with what drug?
Cytarabine (anti-metabolite) in combo w/ Idarubicin (anthracycline)
After remission is achieved with AML, what is used to maintain durable remission and to induce cure?
- High dose cytarabine
or
- Hematopoietic cell transplantation
What is the standard 1st-line therapy for CML in previously untreated pt’s in the chronic phase?
Imatinib
Which 2 agents are now indicated as 1st-line tx for chronic phase CML, but were originally used in pt’s intolerant/resistant to imatinib?
Dasatinib and Nilotinib
Other than the tyrosine kinase inhibitors (-nib’s) what other agents are effective against CML?
Busulfan and other oral alkylating agents
What are the 2 most widely used alkylating agents for CLL; which non-classic alkylating agent may also be used?
- Chlorambucil and Cyclophosphamide
- May also use Bendamustine
In the tx of CLL, Chlorambucil is often combined with what?
Prednisone
What are the 2 different combo drugs containing Cyclophosphamide used for tx of CLL?
- COP = Cyclophosphamide + Vincristine + Prednisone
- CHOP = Cyclophosphamide + Doxorubicin + Vincristine + Prednisone
Which purine antagonist can be used for CLL as a monotherapy or in combo with what?
- Fludarabine as monotherapy
- Or in combo with cyclophosphamide and with mitoxantrone (anthracycline)
Which 4 drug combo is used in stage I and IIA of Hodgkin’s lymphoma?
ABVD = Doxorubicin + Bleomycin + Vinblastine + Dacarbazine
Which combo drug regimen can be used in advanced stage III and IV Hodgkin’s Lymphoma and is less toxic in regards to infertility and 2’ malignancies?
ABVD = Doxorubicin + Bleomycin + Vinblastine + Dacarbazine