chris pepper lecture 3

Question 1

what are the 4 types of treatment for CLL?

Answer 1

1. Chemotherapy
2. targeted antibodies
3. targeted therapies
4. CART therapies

Question 2

what are the 3 different mechansms by which targeted antibodies work?

Answer 2

1. complement mediated lysis
   - antibody binds to receptor and recruits complement to the cell to initiate cell death
2. antibody dependent cytotoxicity
   - mantibody binds and signals to other cells such as macrophages to induce a response
3. direct cytotoxic effect
   - especially drugs like ibinituzimab have direct cytotoxic effect of their own

Question 3

what is th first line treatment for CLL for a young fit patient without delp?

Answer 3

• standard treatment of chemo and antibodies
• FCR- fludarabine, clyclophosphamide and rituximab

Question 4

what is the firstline treatment for cll for older unfit px without deletion of 17p?

Answer 4

• they would typically be enrolled onto a clinical trial
• would involve reduced intensity conditioning chemoimmunotherapy
• chemo and antibodies
• BR- bendamustine and rutuximab

Question 5

what are examples of chemotherapy?

Answer 5

• fludarabine
• bendamustine
• pentostatin

Question 6

what are examples of targeted antibody therapy?

Answer 6

• rituximab
• ofatubimab
• obintuzimab

Question 7

what are examples of targeted therapies?

Answer 7

• ibrutinib
• idelalisib

Question 8

what s the goal of novel therapies?

Answer 8

1. use undertanding of biology to imprve therapy
2. develop targeted treatments selected malignant cells, whih are less toxic to healthy cells
3. recruit body’s immune system to fght disease
4. help to improve the effect of existing tx in combination
5. induce longer remission and cure without side effects

Question 9

which study copared ibrutinib to ofatubimab in order to investigate progression free survival?

Answer 9

RESONATE

Question 10

what is the effect of ibrutinib on the tissues vs blood?

Answer 10

• CLL increase in the peripheral blood
• CLL cels decrease in the tissues
• ssems as though CLL cells are being ejected out of the tissues into the blood

Question 11

what are common side effects of ibrutinib?

Answer 11

• thrombocytopenia
• neutropena
• diarrhoea
• anaemia
• fatigue
• MSK paain

Question 12

what is the new paradigm in our understanding of cancer medications?

Answer 12

• the immune system is the agent that improves outcomes
• it can cure people of systemic cancer

Question 13

how does immunoglobulin gene status affect response to FCR?

Answer 13

• those with mutated immunoglobulins have a better response to FCR than those who are unmutated

Question 14

what happens in CAT therapy?

Answer 14

• Px own t cells are harvested from the peripheral blood
• They are transformed through genetic manipulation to express chimeic antigen receptors
• In this case it would be CD19
• T cells are refused into the patient
• These T cells can recognise malignant B cells in the body and target them for treatment