Session 1 Review_ Intro and Immunotherapy Flashcards
Review from 2/12/25 Session
What does staging refer to in solid tumor oncology?
Refers to how large the primary tumor is (T), whether the cancer is spreading to lymph nodes (N), and whether it has metastasized (M). Most common criteria used: TNM
Staging at diagnosis is the most important predictor of survival.
Importance of staging at time of diagnosis
Predicts survival, guides treatment (curative vs. palliative)
What is grading in the context of solid tumors?
Description of the cellular characteristics of a malignancy, usually via microscope. The higher the grade, the more aggressive the cancer.
What characterizes a low-grade tumor?
Retains many characteristics of the originating cell type, associated with less aggressive behavior and more favorable prognosis.
What is histology?
The study of tissue under the microscope to identify the type of cells the cancer originated from.
Central to diagnosing a cancer.
What are molecular studies in oncology?
Includes techniques like FISH, chromosomal microarray analysis, cytogenetic analysis, and Next Generation Sequencing, Oncomine.
Ways to identify targetable mutations like oncogenes.
What is immunohistochemistry (IHC)?
Identifies specific proteins expressed on tissue. Exploits the specific binding between an antibody and antigen.
What is germline testing?
Testing that looks at healthy DNA from a patient’s blood for inherited genetic changes.
Define advanced cancer
Cancer unlikely to be cured, including all metastatic cancers and some stage IIIb non-small cell lung cancers.
What is immunotherapy?
Therapy that enhances the immune system’s ability to kill tumor cells.
What is chemotherapy?
Cytotoxic treatment that kills cells at different parts of the cell cycle.
What is a partial response (PR) in cancer treatment?
At least 30% decrease in lesions without new lesions
Based on RECIST criteria
What defines complete response (CR) ?
Disappearance of all lesions with normalization of tumor marker levels.
Based on RECIST criteria
What is overall survival?
Time from treatment initiation until death.
What is progression-free survival?
Time from treatment initiation until disease progression or worsening OR death
What are the 3 most common side effects of immunotherapy?
Dermatologic toxicities (rash), GI Toxicities (diarrhea), Musculoskeletal toxicities (Myalgias/Arthralgias)
What is maintenance therapy?
is usually long-term and aims to sustain disease control and prolong survival. So this doesn’t always mean the cancer is gone - but maybe it’s stable, and the goal here is to keep it stable.
What is adjuvant therapy?
Treatment given after surgical intervention.
What is neoadjuvant therapy?
Treatment given before surgical intervention.
What is Salvage Therapy?
Therapy that is put together after the initial lines were ineffective.
Typically palliative in nature (for advanced solid-tumor cancers)
What is Definitive Treatment?
Goal is Curative or to achieve Remission
What is Consolidative therapy?
short-term therapy and aims to deepen the response post-initial treatment, aiming to improve progression-free survival (PFS) and overall survival (OS)
What is considered disease progression (PD) in cancer?
When the lesions have increased in size by at least 20% or there are new lesions on scans
Based on RECIST criteria
What is considered stable disease (SD)?
Lesions may be the same or slightly smaller or slightly larger, but does not fit criteria for PR, CR, or PD. And no new lesions
Based on RECIST criteria
Overall Response Rate (ORR)
A composite value: all patients with partial response (PR) plus patients with complete response (CR). Commonly used as a surrogate for measuring overall survival
PR + CR = ORR
Durable Control Rate (DCR)
A composite value: all patients with partial response (PR) plus patients with compelte response (CR) plus patients with stable diseae (SD). Studies suggesting this may be a better surrogate marker for overall survival compared to overall response rate (ORR)
PR + CR + SD = DCR
Median Survival, or Median Overall Survival
A summary statistic of overall survival which is an outcome measured in studies. The time point where half of the patients are still living, half the patients have died in a particular study. Most predictive outcome measure to identify prognosis in terms of time.
Best Supportive Care
Management of disease related and treatment related side effects such as symptoms (nausea / pain, etc), cytopenias (transfusions), volume losses (IV fluids)
What does the following abbreviation stand for:
IO
Immuno-oncology, Immunotherapy
What are these?
PD-1 and CTLA-4
Examples of immune checkpoints, expressed on T-cells
Define:
Immune Checkpoints
Regulatory proteins (PD-1, CTLA-4) which, when bound to corresponding ligand on another tissue (ie cancer), turns off the immune response.
Define:
Immune checkpoint inhibitors
Type of immunotherapy that blocks immune checkpoints, allowing T-cells to recognize and attack cancer cells. Enhances anti-tumor immune response.
What does the following abbreviation stand for:
irAEs
Immune-related adverse events (side effects from immunotherapy)
What are immune related adverse events?
Unintended effects of the immune checkpoint inhibitor-mediated activation of the immune system causing some form of inflammation and can occur in any organ system.
Durvalumab: mechanism of action
PD-L1 inhibitor or anti-PD-L1
Type of Immune checkpoint inhibitor, immunotherapy
Pembrolizumab: mechanism of action
PD-1 inhibitor or anti-PD-1
Type of Immune checkpoint inhibitor, immunotherapy
Nivolumab: mechanism of action
PD-1 inhibitor or anti-PD-1
Type of Immune checkpoint inhibitor, immunotherapy
Ipilimumab: mechanism of action
CTLA-4 inhibitor
Type of Immune checkpoint inhibitor, immunotherapy
What does it mean to be an “exceptional responder” to immunotherapy?
Individuals who respond far beyond the typical expectations in terms of depth (how much the tumor shrinks) and/or duration (how long the response lasts).
What are the 3 most commonly reported side effects of chemotherapy?
Myelosuppression (i.e. pancytopenia, leukopenia, anemia, thrombocytopenia), Fatigue, Nausea
What is the first line treatment for an irAE? (immune related adverse event?)
Steroids
What is the median overall survival for patients with advanced melanoma? (Based on Checkpoint 067 study)
6 years or 72 months (note that this study excluded patients with brain metastases)
What is the median overall survival for patients with advanced melanoma with brain metastases?
2 years
What is the median overall survival for patients with advanced melanoma with leptomeningeal spread?
Less than 2 years
What dose of prednisone or dexamethasone is considered safe to use while someone is receiving immunotherapy? (After discussion with oncology!)
Max of Prednisone 10 mg / day or Dexamethasone 2 mg / day
What is the most commonly reported organ system affected by immune related adverse event (irAE)?
Dermatologic toxicity: rash, dry mouth, mucositis
