Targeted Cancer Therapies

Question 1

What are the three stages of immunoediting?

Answer 1

Elimination
equilibrium
escape

Question 2

How is metastatic cancer treated?

Answer 2

Surgery
chemotherapy
radiotherapy
immunotherapy

Question 3

What are the general approaches to immunotherapy?

Answer 3

Vaccination strategies
non-specific therapies
antibody therapies
cell based therapies

Question 4

What is aldara?

Answer 4

A viral mimic

Question 5

Interleukin 2 is a non-specific immunotherapy which acts to drive the T cell response. What is the problem with this therapy?

Answer 5

It has a very narrow therapeutic index and can be very toxic

Question 6

What are the possible cell therapies which can be used in cancer treatment?

Answer 6

Haematopoietic stem cells
tumour infiltrating T cells
dendritic cell vaccines
NK cells
gamma delta T cells
virus specific T cells
genetically engineering T cells

Question 7

PDL-1 blockers are monoclonal antibodies which can be used in the treatment of some cancers. What does PDL1, expressed on some cancers do?

Answer 7

PDL1 binds to its receptor on T cells to ‘switch off’ the T cell and down regulate the immune response to the cancer

Question 8

CTLA-4 blockers are monoclonal antibodies which can be used in the treatment of some cancers. What does CTLA-4, expressed on some cancers do?

Answer 8

CTLA4 binds to its receptor on T cells to ‘switch off’ the T cell and down regulate the immune response to the cancer

Question 9

What is involved in the process of haematopoietic stem cell transplants in cancer therapy?

Answer 9

Mobilisation of the donor/patient
storage of haematopoetic stem cells
killing of the cancer
re-infusion of haematopoetic stem cells into the ‘clean system’
recovery of innate and adaptive immune systems

Question 10

What are the advantages of using autologous stem cells in haematopoietic stem cell transplants for cancer patients?

Answer 10

No chance of graft vs host disease

Question 11

What are the disadvantages of using autologous stem cells in haematopoietic stem cell transplants for cancer patients?

Answer 11

Increased chance of remission compared to use of allogeneic cells

Question 12

What is involved in provenge cancer therapy?

Answer 12

Isolation of monocyte dendritic cell precursors
generation of these cells which are simultanously loaded with cancer antigens
rein fusion of cells to generate an anti-tumour response

Question 13

What are CAR-T cells?

Answer 13

Genetically engineered to produce an artificial T cell receptor

Question 14

Give an example of a CART cell used in the treatment of B cell lymphoma?

Answer 14

Kymriah

Question 15

Specific T cells which are sensitive to the EBV virus can be used in the treatment of transplant patients with what type of cancer?

Answer 15

B cell lymphoma

Question 16

In chronic myeloid leukaemia there is over expression of Abl leading to uncontrolled cell division. Which targeted therapy drug can be used to block Abl to prevent this?

Answer 16

Imatinib

Question 17

What are the advantage of newer targeted treatments for cancer?

Answer 17

More selective for cancer cells and less selective for normal cells
less side effects
can given higher doses
potentialy. more anti-cancer effects

Question 18

What are the disadvantages of newer targeted treatments for cancer?

Answer 18

Hard to find drugs which switch pathway back on i.e. when there are mutations in tumour suppressor genes
Targeted drugs are not available for most patients
Requires biopsies to be performed (carries risk)
Most tumours not driven by single, draggable mutation
Cancers can mutate to become resistant to specific therapies

Question 19

Give examples of specific target therapy drugs used in the treated of non small cell lung cancers?

Answer 19

Cirzotinib

Erlotinib

Question 20

What is a predictive marker?

Answer 20

A marker which predicts which patients will benefit from a specific treatment which helps choose which drug to use and is the basis of precision medicine

Question 21

What is a prognostic marker?

Answer 21

A marker which informs about the outcome regardless of treatment so can help decide which patients to treat but not how to treat them