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Oncology > Monoclonal Antibodies > Flashcards

Monoclonal Antibodies Flashcards

1
Q 
"One Source Against" describes the natural protein (immunoglobulin) that can be engineered to bind to certain targets in the body and on cells, with a variety of purposes and effects. What class of chemotherapeutic agents is this characterizing? 
A) Antimetabolites 
B) Alkylating agents and platinums
C) Microtubule inhibitors
D) Monoclonal antibodies
A

D) Monoclonal antibodies

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2
Q

___ area area of antibody is variable while ____ area of antibody is constant.
A) Murine; Antigen binding (Fab)
B) Antigen binding (Fab); Biologic activity mediation (Fc)
C) Antigen binding (Fab); Murine
D) Murine; Biologic activity meditation (Fc)

A

B) Antigen binding (Fab); Biologic activity mediation (Fc)

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3
Q

What was made to resolve the initial design issues of human immune system making anti-murine antibodies, resulting in a faster clearance and diminished therapeutic effect?
A) Make more murine (0% human) antibodies from other animals
B) Begin to adjust the constant region of the antibodies
C) Create the recombinant production of chimeric antibodies with constant regions of human immunoglobulins with murine derived antigen binding portion of the molecule
D) Create the antigen variable region of human immunoglobulins with murine-derived constant regions of the molecule

A

C) Create the recombinant production of chimeric antibodies with constant regions of human immunoglobulins with murine derived antigen binding portion of the molecule

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4
Q

The goal is creating chimeric antibodies is to make a more humanized antibody to decrease the potential for immunogenicity. Each generation has different suffixes to show its distinction (i.e. chimera is -ximab). True or False?

A

True

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5
Q

What are the advantages to monoclonal antibodies? Select all that apply
A) Long half-lives
B) Extended penetration
C) Not substrates of efflux pumps (fewer DDIs)
D) Designed to bind to antigen with high affinity

A

A) Long half-lives
C) Not substrates of efflux pumps (fewer DDIs)
D) Designed to bind to antigen with high affinity

B) Limited penetration (periphery of tumor tissue) unless using smaller fragments

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6
Q

Match the type of antibody with its description:

i. Naked Monoclonal Antibodies
ii. Conjugated Monoclonal antibodies
iii. Bispecific Monoclonal Antibodies

A) Two attached antibodies, one which attach the cancer cells and one which attaches T cells
B) Looks like an IgG without anything fancy (i.e. marker’s for body’s immune system, immune checkpoint inhibitors, block antigens that help cancer growth)
C) Cell gets internalized then the chemo/radiation is released directly to the cancer cell

A

i. Naked Monoclonal Antibodies (B)
ii. Conjugated Monoclonal antibodies (C)
iii. Bispecific Monoclonal Antibodies (A)

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7
Q

____ bind antibody to complement component 1, which activates downstream cascade and MAC attack, while ____ uses antibodies to bring immune effector cells (NK, monocyte, macrophage, granulocyte).
A) Angiogenesis Inhibition; Antibody-dependent cytotoxicity
B) Complement-dependent cytotoxicity; Radioimmunotherapy
C) Complement-dependent cytotoxicity; Antibody-dependent cytotoxicity
D) Immune checkpoint inhibitor; antibody-dependent cytotoxicity

A

C) Complement-dependent cytotoxicity; Antibody-dependent cytotoxicity

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8
Q 
Which of the following are examples of transmembrane signaling - generate or interrupts an intercellular signal to produce apoptosis? 
A) Radioimmunotherapy 
B) Bispecific antibody therapy
C) Angiogenesis inhibition 
D) Immune checkpoint inhibitor
A

C) Angiogenesis inhibition (VEGF)

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9
Q

Inactivating or limiting T-cell through CTLA4 binding and inhibiting T-cell proliferation
& cytokine release by monitoring PD-1 and PD-L1 is done by which drugs?
A) Ipilimumab
B) Nivolumab
C) Pembrolizumab
D) Atezolizumab

A

A) Ipilimumab (CTLA4)
B) Nivolumab (PD1)
C) Pembrolizumab (PD1)
D) Atezolizumab (PD-L1)

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10
Q

What is the difference between bi-specific antibodies and chimeric antigen receptor (CAR) T-cell therapies?
A) One arm binds to tumor antigen and other arm activates B cells
B) One arm binds to tumor antigen and other arm activates NK and T-cell
C) T-cells harvested and modified to express a tumor specific antibody
D) T-cells are attached to radioimmunotherapy and retransplanted into the body
E) B & C

A

B) One arm binds to tumor antigen and other arm activates NK and T-cell
C) T-cells harvested and modified to express a tumor specific antibody
E) B & C

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11
Q

What is the difference between bi-specific antibodies and chimeric antigen receptor (CAR) T-cell therapies?
A) One arm binds to tumor antigen and other arm activates B cells
B) One arm binds to tumor antigen and other arm activates NK and T-cell
C) T-cells harvested and modified to express a tumor specific antibody
D) T-cells are attached to radioimmunotherapy and retransplanted into the body
E) B & C

A

B) One arm binds to tumor antigen and other arm activates NK and T-cell
C) T-cells harvested and modified to express a tumor specific antibody
E) B & C

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12
Q 
What are some of the immediate toxicities that come with mAbs?
A) Infection
B) Systemic inflammatory response 
C) Local injection site reaction 
D) Cardiotoxicity
A

B) Systemic inflammatory response (CRS, Infusion reaction, IgE-mediated anaphylactic)
C) Local injection site reaction (erythema, pyrexia, influenza like syndrome)

Corrected Wrong Answers:
A) Infection (Delayed - immune deficiency)
D) Cardiotoxicity (Delayed)
+Drug-induced thrombocytopenia, HTN, thyroid/lung/skin inflammation and toxicity

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13
Q

Trastuzumab is an example of what kind of monoclonal antibody?
A) antibodies can be attached to chemotherapeutic agents to deliver chemo directly to malignant cells
B) antibodies can target cell-type specific markers and attack those malignant cells
C) antibodies can be bound to radiation, to deliver radiation to a target
D) antibodies can target overexpressed proteins driving cancer growth

A

D) antibodies can target overexpressed proteins driving cancer growth

median survival increased during 1990-2010 from 20 to 31 months

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14
Q 
What is the drug target for Trastuzumab?
A) CTLA4
B) CD38
C) HER-2/neu
D) CD20
A

C) HER-2/neu - transmembrane tyrosine kinase of EGFR family (HER2+ breast cancer)

EGFR responsible for growth division and proliferation of cells (normal and cancer) by 1) affecting signal cascade and 2) recruiting cytotoxic cells (NK cells)

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15
Q 
What is the most significant toxicity related to Trastuzumab?
A) Cardiotoxicity
B) Infusion reaction
C) Diarrhea
D) Severe infection
A

A) Cardiotoxicity

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16
Q 
Which two are used in combination as they both bind to HER2 and will inhibit heterodimerization?
A) Blinatumomab + Tocilizumab
B) Trastuzumab + Pertuzumab
C) Rituximab + Trastuzumab 
D) mAbs are usually used alone
A

B) Trastuzumab + Pertuzumab

17
Q 
Which of the following is an antibody example of antibodies being attached to chemotherapeutic agents to deliver chemo directly to malignant cells?
A) Trastuzumab
B) ado-trastuzumab emtansine
C) Rituximab
D) Blinatumomab
A

B) ado-trastuzumab emtansine (antibody-drug conjugate of trastuzumab to cytotoxic agent mertansine (DM1)

Mertansine delivered and enters cell and binds to tubulin. Used in advanced breast cancer

18
Q 
What kind of antibodies can be used for both hematologic and oncologic malignancies? 
A) Rituximab
B) Blinatumomab
C) Ado-Trastuzumab Emtansine
D) Tocilizumab
A

A) Rituximab: can target cell type-specific markers and attack those malignant cells

19
Q 
What is the drug target for Rituximab?
A) CD20 
B) NK Cells 
C) Macrophages
D) Den
A

A) CD20 in B cells (normal and neoplastic)
CD20 attracts complement cascade –> MAC made. Also Rituximab attracts NK cells and macrophages which will attack cancerous B cells

20
Q

CD stands for what?

A

Cluster of Differentiation: protocol used for the identification of cell-surface molecules, providing targets for immunophenotyping of cells

21
Q

Match the cells with its CD

i. T-lymphocytes
ii. Cytotoxic T cells
iii. T-helper cells
iv. B-lymphocytes

A) CD20+
B) CD22+
C) CD38
D) CD3+
E) CD4+
F) CD8+
A

B-lymphocyte CD20, CD22, CD38
Cytotoxic T cells CD8
T-helper cells CD4
T-lymphocyte CD3

22
Q

Initial infusion reaction is related to complement activation, so which symptoms would follow?
A) Dizziness, HTN, HA, Fever & chills, nausea
B) ARDs, MI, Ventricular fibrillation, cardiogenic shock
C) Dizziness, HTN, MI, ARDs
D) Fever & chills, nausea, cardiogenic shock

A

A) Dizziness, HTN, HA, Fever & chills, nausea

Rare and Severe ADR
B) ARDs, MI, Ventricular fibrillation, cardiogenic shock

23
Q 
How would you resolve infusion reaction? 
A) Slowing infusion rate
B) Decreasing dose 
C) Temporarily interrupting infusion
D) Pre-meds
A

A) Slowing infusion rate
C) Temporarily interrupting infusion
D) Pre-med

*infusion-related symptoms generally decrease in incidence with each administration

24
Q 
Which premeds are required for Rituximab?
A) Hydrocortisone
B) Diphenhydramine
C) Acetaminophen
D) Adequate IV fluids/hydration
A

B) Diphenhydramine
C) Acetaminophen
D) Adequate IV fluids/hydration

25
Q 
Which of the following antibody can be bound to radioactive isotope to deliver targeted radiation?
A) Daratumumab
B) Ibritumomab
C) Rituximab
D) Ado-Trastuzumab
A

B) Ibritumomab

26
Q

What is special about Daratumumab?
A) It is attached to a chemotherapeutic agent
B) It is attached to a radioactive isotope
C) It has a hyaluronidase-fihj form can be given SQ
D) It can be used in solid and hematologic malignancies

A

C) It has a hyaluronidase-fihj form can be given SQ (Darzalex faspro)

27
Q 
What is the drug target for Daratumumab?
A) CD20
B) CD38
C) CD8
D) CD22
A

B) CD38 (on B cells)

28
Q 
Which antibody can be used to indirectly kill cancer by inhibiting VEGF which will in turn inhibit angiogenesis, thus blocking off a cancer's supplies for growth?
A) Cetuximab
B) Blinatumomab
C) Bevacizumab
D) Tocilizumab
A

C) Bevacizumab

29
Q 
How does stopping angiogenesis (VEGF) provide a good pathway for a mAb?
A) Decrease the tumor blood supply
B) Decrease blood veseel permeability 
C) Improves delivery of chemotherapy 
D) All of the above
A

A) Decrease the tumor blood supply
B) Decrease blood veseel permeability
C) Improves delivery of chemotherapy
D) All of the above

30
Q 
What are the main consequences to monitor for when administering Bevacizumab?
A) HTN
B) Proteinuria
C) Bleeding
D) Impaired Wound Healing
A 
A) HTN
B) Proteinuria
C) Bleeding
D) Impaired Wound Healing
\+ may worsen CHF, increase risk of DVT or PE
31
Q 
What is the drug target for Cetuximab that can be used to turn off cancer's growth signaling cascades?
A) EGFR
B) VEGF
C) CD20
D) CD38
A

A) EGFR

32
Q

Since EGFR also known as epidermal growth factor that regulates growth, survival and proliferation, what kind of side effect profile would it have?
A) Cardiotoxicity
B) Hypomagnesemia
C) Dermatologic toxicities: acne like rash
D) B & C

A

B) Hypomagnesemia
C) Dermatologic toxicities: acne like rash
D) B & C

33
Q 
\_\_\_ is that bind to multiple targets at once, and form immune-system to cancer connections. This one specific binds to CD3 on the T cell and CD19 surface antigen on B cell.
A) Cetuximab
B) Blinatumomab
C) Bevacizumab
D) Tocilizumab
A

B) Blinatumomab

34
Q 
With the unique mechanism of Blinatumomab, what is the related toxicity?
A) Neurologic toxicities 
B) CRS
C) Cardiotoxicity 
D) A & B
A

A) Neurologic toxicities
B) CRS
D) A & B

35
Q 
What drug is used to calm or disable the immune system, as seen in CRS or COVID 19?
A) Cetuximab
B) Blinatumomab
C) Bevacizumab
D) Tocilizumab
A

D) Tocilizumab (IL-6 Inhibitor)

Oncology (6 decks)

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