Immunity to tumors 2 Flashcards
What suffix is used for monoclonal antibodies
-mab
What does rituximab target, how does it cause cell lysis
CD-20 (non-Hodgkin’s lymphoma), compliment fixation, antibody dependent cell mediated cytotoxicity, induction of apoptosis
Due to rituximab being a chimeric antibody what are precautions that must be taken prior to infusion
premedication, slowly titrate infusion, vigilant surveillance
What viral disease must be screened prior to first dose of rituximab, if present what is given as well
Hepatitis B, entecavir
What drug is used for prophylaxis of tumor lysis syndrome due to rituximab
Allopurinol
What are actions that should be done if there is a moderate infusion reaction, severe infusion reaction (anaphylaxis)
stop infusion, administer corticosteriods and H1/H2 blockers, restart infusion at slower rate/ administer hydration, epinephrine and bronchodilators, rechallenge
What are antibody-drug conjugates comprised of
Antibody, linker, cytotoxic agent
What does the linker do in antibody-drug conjugates
attaches the cytotoxic agent to the antibody
What does anti-CTLA-4 do
Binds to CTLA-4 instead of CTLA-4 binding to B7
What is Ipilimumab
monoclonal antibody to CTLA-4
What are dermatological side effects to using Ipilimumab, how often does it happen
itcing and rash, 50%
How are dermatological side effects managed for Ipilimumab
oral antipruritics, grade 3/4 require topical and/or oral corticosteroids
What gastrointestinal side effects to using Ipilimumab
diarrhea, abdominal pain, blood and mucous in stool, ileus
How are gastrointesinal side effects managed for Ipilimumab
corticosteroids for proloned grade 2 (less than one week) or any grade 3/4, discontinue for grade 3/4
What is grade 2, grade 3 in colitis and diarrhea
Colitis: grade 2- abdominal pain, mucus or blood in stool grade 3- severe abdominal pain
Diarrhea: grade 2- increase of 4-6 stools per day grade 3 increase of seven or more stools
What is grade 4 and grade5 in colitis and diarrhea
life-threatening, death
What are endocrine side effects in using Ipilimumab
fatigue, headache, abnormal thyroid test, hypotension
How are endocrine side effects in using Ipilimumab managed
withhold treatment, treat hyper or hypothyroidism
What are pulmonary side effects in using Ipilimumab
shortness of breath, inflammation of walls of aveoli (pneumonitis)
How does PD-1/PD-L1 antagonists work
inhibit inreactions on T-cell and/or tumor cell
T/F: Anti-PD-1 monoclonal antibodies inhibit interactions on tumor cells while Anti-PD-L1 inhibt interactions on T cells
False: Anti-PD-1 inhibt T-cell and Anti-PD-L1 inhibit interactions on tumor cells
What are the PD-1 antibody medications
Nivolumab (Opdivo), Pembrolizumab (Keytruda)
What are the PD-L1- antibody medications
Atezolizumab (Tecentriq), Avelumab (Bavencio), Durvalumab (Imfinzi)
What are features of PD-1/PD-L1 antagonists
convienient dosing every 3-4 weeks, monotherapy or combination, no premedications required
T/F: Steroids should be avoided when using PD-1/PD-L1 antagonsits
True
How do bi-specific T cell (BITEs) engagers work, how are they taken
Combination of CD-19 single chain antibody connected to Cd-3 antibody via linker connecting T cells to B- cells, given as continous infusion for 28 days then 14 days off treatment
What are the adverse reactions to (BITEs)
cytokine release syndrome, neurotoxicity
What medication is a bi-specific T cell engager
Blinatumomab (blincyto)
What are some cytokine release syndrome side effecs
headache, high fever, hypotension, rash, fatigue, dyspnea
What are some cytokines released during cytokine release syndrome
IFN-gamma, IL-6, IL-2, IL-8, or IL-10, TNF-alpha
What drug is given with grade 3 or 4 cytokine release due to blinatumomab, what does it do
Tocolizumab (actemra), IL-6 receptor antagonist that causes a reduction in cytokine and acute phase reactant production
How often does neurtoxicty occur in BiTEs therapy, when do symptoms occur, what should be avoided
2 out of 3 patients, 8 weeks, refrain from driving
What are the premediacations for CAR-T therapy
Acetaminophen and Diphenhydramine
What are side effects of CAR-T therapy
Cytokine release syndrome, neurotoxicity, anaphylaxis,
