New treatments for blood cancers 2 (ignore)

Question 1

What is the idea behind using molecular/targeted cancer treatments?

Answer 1

• Target pathway specific to the cancer cell.
• Avoid side effects.
• More effective than chemotherapy.

Question 2

What is the main molecular/targeted cancer treatment which can be used in CML ?

Answer 2

Tyrosine kinase inhibitors: (think ‘tinib’)

• Main one being Imatinib

Think this is now the main treatment for CML - it inhibits tyrosine kinase action whcih is stimulated by BCR-ABL-1 gene on the philideliphia chromsome present in pretty much all CML

Question 3

How effective is tyrosine kinase inhibitors in the treatment of CML ?

Answer 3

Results in CML now being:

• A chronic disease.
• Blood counts normal,
• Chromosomes normal, no detectable BCR-ABL in blood.

Question 4

What are the side effects of tyrosine kinase inhibitors ?

Answer 4

Most tolerate very well. Some side effects:

• diarrhoea,
• fluid in lungs,
• neutropenia.

Question 5

What are the cancer drugs which can be used to act on the abnormal signalling pathways inside CLL and lymphoma cells and how does this work?

Answer 5

Ibrutinib (although says tinib this one isnt a tyrosine kinase inhibitor) and Idelalisib

Blockage of these signalling proteins can cause apoptosis, even if P53 is abnormal.

Question 6

When would Ibrutinib and Idelalisib therapy be considered ?

Answer 6

Effective in low grade NHl and B cell CLL that don’t respond to rituximab and chemotherapy.