New and Future Tx of Blood Cancer Flashcards
How do chemo and radiotherapy attempt to kill cancer?
- damages DNA of cells as they divide
=> they are flagged as damaged
=> are killed by apoptosis
What is the difference in cell death between low and high dose chemotherapy?
Low dose chemo - induces apoptosis (less side effects)
high dose chemo - causes necrosis (more side effects)
How is radiotherapy used in lymphoma and Chronic Lymphocytic Leukaemia?
- radiotherapy directed at affected nodes
- in CLL patients often have lymphadenopathy
What are the potential side effects of chemotherapy?
hair loss
N+V
neutropenic infection
tiredness
What supportive treatment can be offered to patients undergoing chemotherapy?
- 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
How are long term effects of chemo avoided in certain patients?
- decreasing chemo dose
- missing radiotherapy
How is response to chemo monitored in Hodgkins lymphoma?
- PET scan
If a large enough response has been generated to chemo in Hodgkins lymphoma what can be done throughout the next 3 cycles?
Miss out the more toxic drugs used in cycles 3-6 of chemo
What targeted therapies can now be used to treat haematological cancer?
- monoclonal Ab
- Biological agents
- Molecular targeted agents
What monoclonal Ab can be used to target B cells?
Rituximab targets CD20 on B cells
binds to them and attracts body’s own leucocytes ot break this down
Rituximab can be combined with chemotherapy. TRUE/FALSE?
TRUE
- known as R-CHOP
(CHOP stands for the combination of chemo drugs used)
What other B cell antibodies can patients be given if they do not respond to rituximab?
Ofatumunab
Obinutumab
- these kill B cells more directly
Brentuximab Vedotin is a Targeted chemotherapy used in Hodgkins disease. What does this mean?
Targeted Ab at the CD30 antigen on B cells
- also has chemotherapy agent attached to the antibodies
What are the side effects of targeted chemo for hodgkins lymphoma?
nerve damage
neutropenia
fatigue
What are biological treatments?
- not chemo (don’t affect dividing cells)
- proteosome inhibitors and IMIDs
Describe how proteosome inhibitors work
proteosome is the dustbin for old protein in cells
it breaks them down to amino acids
no proteosome causes accumulation of toxic proteins
=> apoptosis
When are proteosome inhibitors used?
- low grade cancers
- especially where chemo isn’t as effective
What are IMIDs and when are they used?
- Immuno-Modulatory- Imide drugs
- thalidomide derivative
- can help with remission in low grade cancers that no longer respond to chemo
What are the side effects of IMIDs?
- nerve damage
- risk to foetus (if applicable)
- affects blood count
- can cause other cancer
What is meant by molecular targeted treatments?
- Aim to stop tumours evading the immune system
e. g. Tyrosine Kinase inhibitors in CML
What side effects do tyrosine kinase inhibitors such as Imatinib, cause?
diarrhoea
fluid in lungs
neutropenia
When are TK inhibitors like imatinib and idelalisib usually used?
low grade NHL
B cell CLL
- especially if patients dont respond to rituximab/chemo
WHat are checkpoint inhibitors?
- 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
What are the side effects of checkpoint inhibitors?
rash
decreased platelet count
fatigue
In what types of disease are checkpoint inhibitors normally used?
Relapse/Resistant Lymphoma
- very well tolerated in Hodgkin’s patients
What other immune therapies can be used to treat haematological cancer?
bone marrow transplant
adaptive immunotherapy (CAR-T cell therapy)
- modifies patients T cells to recognise cancer as foreign
