Treatment for Blood Cancers Flashcards
how does chemo and radiotherapy work
damaged DNA of cancer cells as it divides
cell initiates apoptosis via P53
what do mutations in P53 mean (seen in chronic lymphocytic leukaemia)
make it harder to treat with chemo and radio
why do you try to use a lower dose of chemo and radio
lower dose causes apoptosis and formation of blebbing- cell breaks down into several apoptotic bodies which are phagocytosed= no inflammation
higher doses cause the cell to swell, plasma membrane to rupture = cellular and nuclear lysis= inflammation
lower dose= less side effects
why do lymphomas/ CLL/ acute leukaemias responds well to chemo and radio
lymophocytes undergo apoptosis in normal lymph node
lymphoma and CLL responds to chemo and radio
AL respond to chemo (cells dividing more quickly)
what causes the side effects of chemo and radio
normal cells having their DNA damaged
what are the side effects of chemo and radiotherapy
immediate: hair loss, nausea and vomiting, neutropenic infection, TIREDNESS
long term: heart damage, lung damage, other cancers
what supportive therapies should be given for blood cancers
prompt treatment of neutropenic fever/ infection broad spectrum antibiotics red cell and platelet infusions growth factors (GCSF) prophylatic antibiotics and antifungals
who is given prophylatic antifungals e.g. itraconazole, posaconazole
all at risk (compromised immune system )
when are pet scans used
to improve radiotherapy treatment in HL
when would you want to increase the doses of chemo and radio
in those who need it for cure- have to accept the side effects
what chemo therapy regimes are used for HL
ABVD 6 cycles
avoid side effects by missing out B (bleomycin) in cycles 3-6
if PET +ve after 2 cycles escalate to escBEACOPP
what are the targeted therapies for blood cancers
monoclonal antibodies (rituximab)
biological agents
molecularly targeted treatments
how do monoclonal antibodies work
immune treatment- affect only cells which possess target protein
(avoid side effects)
currently used in combo with chemo
what is FCR (rituximab) used to treat
CLL
what is RCHOP (rituximab) used to treat
high grade B cell NHL
what is R- chemo (rituximab) and maintenance rituximab used to treat
mantel cell NHL
name anti B cell antibodies used in monoclonal antibody treatment
rituximab
ofatumumunab
obinutumab
(last two used when not respond to rituximab)
what is bretuximan vedotin
targeted chemo therapy used in hodgkins disease (antibody drug conjugate)
what are the side effects of targeted chemotherapy
nerve damage
low neutrophils
fatigue +++
how do biological treatment work
(not targeted to malignant/ dividing cells= side effects)
proteosome inhibitors- prevents breakdown of old proteins in cell into amino acids= toxic proteins accumulate= apoptosis
IMIDs- method not understood
give an example of a proteosome inhibitors
bortezomib- low grade NHL
what are the side effects of proteosome inhibitors
nerve damage and platelets
name an IMID and their side effects
lenalidomide nerve damage risk to detus effect on blood counts other cancers
give examples of molecular/ targeted treatments
tyrosine kinase inhibitors: CML
targeting malignant B cells: ibrutinib and idelalisib= CLL/ NHL
stopping tumour evade the immune system= nivolumab
how do molecular/ targeted treatments work
target pathway specific to cancer
avoid side effects and more effective than chemo
when gene when mutated causes CML
BCR-ABL
what drug inhibits BCR-ABL
imatinib (tyrosine kinase inhibitors)
what are the side effects of tyrosine kinase inhibitors
generally well tolerated
diarrhoea
fluid in lungs
neutropenia
what have tyrosine kinase inhibitors allowed
CML to be a chornic disease
what drugs affect B cell signalling pathways
ibrutinib and idelalisib
used in low grade NHL and B cell CLL that dont respond to rituximan and chemo
what are the side effects of ibrutinib and idelalisib
idelalisib: diarrhoea, rash, fatigue, liver abnormality, fever
ibrutinib: fever, low platelets, anaemia, SOB
what do checkpoint inhibitors do e.g. nivolumab
prevent the cancer evading to immune system
used in relapsed/ resistant lymphoma
what are the side effects of nivolumab
rash decreased platelets fatugue pyrexia diarrhoea pruritus (most resolve with dose reduction)
what is immune therapy
allogenic bone marrow transplant (from matched donor)
T cells from donor attack cancer
risk of graft verus host disease (immune attack of normal cells)
what is adoptive immunotherapy
makes patients own immune cells recognise the cancer as foreign and attack it (avoid graft versus host disease)
CART cell therapy (patients on T cells are genetically modified antigen receptors added to then and infused back to patient)
