New treatments for blood cancers (ignore) Flashcards
How does chemo and radiotherapy work ?
- Damages DNA of cancer cells as it divides (mitosis).
- Cell recognises it is damaged beyond repair and dies by process of apoptosis (programmed cell death).
- p53 is one of the genes which can activate apoptosis in this situation
Mutation in what gene can make CLL very difficult to treat with chemo and radio?
Mutations of P53 - think because you can damage the cell with the chemo and radio but its more likely to still divide cause this gene isnt stimulating apoptosis
Why do lymphoma/CLL and acute leukaemia respond better than most other cancers to chemo and RT ?
- Lymphocytes are keen to undergo apoptosis in the normal lymph node.
- Lymphoma and CLL cells can be triggered to undergo apoptosis readily with chemo- or radiotherapy. (cancers of lymphocytes essentially)
- Acute leukaemia is dividing do quickly-more cells are dividing and so are affected by chemotherapy.
What are the side effects of chemo and radiotherapy and why does this happen ?
Side effects occur because normal cells are affected by the treatments
Immediate effects
- Hair loss, nausea and vomiting, neutropenic infection.
- Tiredness +++
Long term effects
- Heart damage, lung damage, other cancers.
What is the supportive therapy for bone marrow failure (often get this with chemo)?
- Prompt treatment of neutropenic fever/infection.
- Broad Spectrum antibiotics.
- Red cell and platelet transfusion.
- Growth Factors (GCSF).
- Prophylactic antibiotics and antifungals to prevent infection occurring in the first place.
What are the prophylactic antifungals given to all patients at risk?
itraconazole or posaconazole
Why do more patients now survive acute leukaemia (not been much change in actual treatment)?
The supportive treatment is better now as previously mentioned
What scan is used in the treatment of hodgkins to monitor wether or not to escalate or descalate treatment ?
PET - this has improved survival rates as not having to expose patients to as toxic a regime or giving them more to more aggressively treat the cancer
Using PET scanning to monitor - a patient with hodgkins has shown to be responding very well to the ABVD chemo treatment and is very likely to be cured so what can be done to reduced the side effects of the chemo treatment on this patient ?
Avoid side effects by missing out Bleomycin in cycles 3-6 (AVD).
Using a PET scan it has shown a patient with hodgkins lymphoma is responding poorly to the chemo what regime can be used to try and treat the cancer more aggressivley ?
Escalate treatment to BEACOPP regime, despite more toxicity.
What are the 3 main types of targeted therapies in treatment of cancer ?
- Monoclonal antibodies.
- Biological agents.
- Molecularly targeted treatments
How do monoclonal antibodies attack cancer cells specifically ?
Affect only cells which possess target protein
Why are the side effects not avoided in monoclonal antibody therapy yet ?
Unfortunately most are currently used in combination with chemotherapy rather than instead of-so same risks
What is the target protein of ratiximab and what cell type is this present on ?
CD20 present on B cells
How does monoclonal antibodies work?
Once bound to the target cell - they have an human IgG Fc domain which results in killer luecocytes to bind and destroy the target cell
