New and Future Tx of Blood Cancer

Question 1

How do chemo and radiotherapy attempt to kill cancer?

Answer 1

• damages DNA of cells as they divide
  => they are flagged as damaged
  => are killed by apoptosis

Question 2

What is the difference in cell death between low and high dose chemotherapy?

Answer 2

Low dose chemo - induces apoptosis (less side effects)

high dose chemo - causes necrosis (more side effects)

Question 3

How is radiotherapy used in lymphoma and Chronic Lymphocytic Leukaemia?

Answer 3

• radiotherapy directed at affected nodes

- in CLL patients often have lymphadenopathy

Question 4

What are the potential side effects of chemotherapy?

Answer 4

hair loss
N+V
neutropenic infection
tiredness

Question 5

What supportive treatment can be offered to patients undergoing chemotherapy?

Answer 5

• prompt treatment of neutropenic infection
• broad spec. antibiotics given if neutropenic and fever >38
• RBC and platelet transfusion if required
• G-CSF given if needed
• prophylactic antibiotics and antifungals

Question 6

How are long term effects of chemo avoided in certain patients?

Answer 6

• decreasing chemo dose

- missing radiotherapy

Question 7

How is response to chemo monitored in Hodgkins lymphoma?

Answer 7

• PET scan

Question 8

If a large enough response has been generated to chemo in Hodgkins lymphoma what can be done throughout the next 3 cycles?

Answer 8

Miss out the more toxic drugs used in cycles 3-6 of chemo

Question 9

What targeted therapies can now be used to treat haematological cancer?

Answer 9

• monoclonal Ab
• Biological agents
• Molecular targeted agents

Question 10

What monoclonal Ab can be used to target B cells?

Answer 10

Rituximab targets CD20 on B cells

binds to them and attracts body’s own leucocytes ot break this down

Question 11

Rituximab can be combined with chemotherapy. TRUE/FALSE?

Answer 11

TRUE
- known as R-CHOP
(CHOP stands for the combination of chemo drugs used)

Question 12

What other B cell antibodies can patients be given if they do not respond to rituximab?

Answer 12

Ofatumunab
Obinutumab

• these kill B cells more directly

Question 13

Brentuximab Vedotin is a Targeted chemotherapy used in Hodgkins disease. What does this mean?

Answer 13

Targeted Ab at the CD30 antigen on B cells

- also has chemotherapy agent attached to the antibodies

Question 14

What are the side effects of targeted chemo for hodgkins lymphoma?

Answer 14

nerve damage
neutropenia
fatigue

Question 15

What are biological treatments?

Answer 15

• not chemo (don’t affect dividing cells)

- proteosome inhibitors and IMIDs

Question 16

Describe how proteosome inhibitors work

Answer 16

proteosome is the dustbin for old protein in cells
it breaks them down to amino acids
no proteosome causes accumulation of toxic proteins
=> apoptosis

Question 17

When are proteosome inhibitors used?

Answer 17

• low grade cancers

- especially where chemo isn’t as effective

Question 18

What are IMIDs and when are they used?

Answer 18

• Immuno-Modulatory- Imide drugs
• thalidomide derivative
• can help with remission in low grade cancers that no longer respond to chemo

Question 19

What are the side effects of IMIDs?

Answer 19

• nerve damage
• risk to foetus (if applicable)
• affects blood count
• can cause other cancer

Question 20

What is meant by molecular targeted treatments?

Answer 20

• Aim to stop tumours evading the immune system

e. g. Tyrosine Kinase inhibitors in CML

Question 21

What side effects do tyrosine kinase inhibitors such as Imatinib, cause?

Answer 21

diarrhoea
fluid in lungs
neutropenia

Question 22

When are TK inhibitors like imatinib and idelalisib usually used?

Answer 22

low grade NHL
B cell CLL

• especially if patients dont respond to rituximab/chemo

Question 23

WHat are checkpoint inhibitors?

Answer 23

• cancer cells can usually “switch off” immune cells in order to evade the immune system
• nivolumab stops cancer cell from doing this by binding to the chemical it releases

Question 24

What are the side effects of checkpoint inhibitors?

Answer 24

rash
decreased platelet count
fatigue

Question 25

In what types of disease are checkpoint inhibitors normally used?

Answer 25

Relapse/Resistant Lymphoma

- very well tolerated in Hodgkin’s patients

Question 26

What other immune therapies can be used to treat haematological cancer?

Answer 26

bone marrow transplant
adaptive immunotherapy (CAR-T cell therapy)
- modifies patients T cells to recognise cancer as foreign