Immunotherapy

Question 1

What is immunotherapy?

Answer 1

A therapy to control the immune system

Question 2

What are examples of passive immunity?

Answer 2

Placental transfer of IgG

Colostral transfer of IgA

Question 3

What are the advantages of passive immunity?

Answer 3

Gives immediate protection

Quick fix

Question 4

What are the disadvantages of passive immunity?

Answer 4

Short term effect, no immunological memory
Serum sickness
Graft versus host disease

Question 5

What are the immunoglobulins for post exposure prophylaxis?

Answer 5

Hep A and B 
Measles 
Polio 
Rubella
Rabies 
Tetanus 
Varicella-Zoster virus

Question 6

What is IVIg?

Answer 6

Plasma derived IgG, key biologic for replacement therapy in primary and secondary immunodeficiency disorders

Question 7

How is IVIg given?

Answer 7

Polyclonal IgG preparation given IV but can also be administered subcutaneously

Question 8

What is the licensed indications for IVIg?

Answer 8

Primary immunodeficiency 
Wiskott Aldrich syndrome 
IgG subclass deficiencies with recurrent infections
Kawasaki disease 
idiopathic thrombocytopenia purpura 
Multiple myeloma/CLL 
Children with HIV 
Gullian-Barre syndrome

Question 9

What is direct immunotherapy?

Answer 9

Antibodies or antibody related fragments that detect an antigen on the tumour cell and destroy the target either by recruiting immune cells or by delivering a toxin or radioisotope to it Target: The tumour

Question 10

What is indirect immunotherapy?

Answer 10

The immune system is activated rendering it able to seek and destroy tumour cells Target: The immune system

Question 11

What are some examples of direct immunotherapy?

Answer 11

Monoclonal antibodies
Chimeric antigen receptors
(CARs)
Bi-specific antibodies

Question 12

What are some examples of indirect immunotherapy?

Answer 12

Tumour vaccines
Dendritic cell vaccines
Adoptive cell transfer
Cytokine therapies
Checkpoint inhibitor therapies
Stimulatory antibodies

Question 13

What is the process of a monoclonal antibody?

Answer 13

Immunisation
Fusion and immortilisation of B cells
Isolation and screening
Expansion or desired hybridoma

Question 14

How does rituximab work?

Answer 14

Specific for CD20 molecule on the cell surface of a small sub population of B cells

Question 15

What is anti TNF alpha used to treat?

Answer 15

Ankylosing spondylitis
Crohn’s disease
Ulcerative colitis

Question 16

How does herceptin work?

Answer 16

Antibody binds HER2 on cancer cells and marks them out for destruction by the immune system

Question 17

What are checkpoint inhibitors?

Answer 17

Allow T cells to identify tumours and kill them

Potential for immune related adverse effects

Question 18

What are some examples of checkpoint inhibitors?

Answer 18

Anti-CTLA-4 antibodies

Anti-PD1/PD-L1 antibodies

Question 19

What is the mode of treatment for dendritic cell vaccines?

Answer 19

Take blood sample from patient
Culture cells in vitro
with cytokines that promote APC function
Transfuse patients with APC after uptake of tumour antigen

Question 20

What are the features of chimeric antigen receptors?

Answer 20

Combine antibody and T cell response to improve immunity
Increases longevity and overcomes T cell tolerance mechanisms
Need to identify a tumour restricted antigen
Tumour escape if antigen no longer expressed