Hematology & Oncology

Front 1

The cells kill by releasing small cytoplasmic granules of proteins called?

Back 1

Perforin and Granzyme

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NK cells are activated by?

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interferon-γ

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Antibodies are recognized by ____ receptors on cells and phagocytes

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Fc receptors

Front 4

tumor-specific antigens (TSA) expressed by tumor cells but
not expressed by normal cells?

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Bcr-Abl

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Cancer caused by the Philadelphia Chromosome?

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chronic myelogenous leukemia (CML).

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CD8 cells must be activated by?

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Th or CD4 cells

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Tumor infiltrating lymphocytes (TILs) are mainly?

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cytotoxic T cells (Tc, CTLs, CD8+)

Front 8

Tumor cells display their own antigen on?

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MHC-I

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Regulatory T cells (T-regS)?

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CD4+ and CD25+

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Regulatory T cells inhibit both?

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inhibit both Th (CD4+, CD25-) and Tc (CTL, CD8+ CD25-) effector cells

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There is a strong correlation between the presence of _____ and the survival of patients with many cancers (e.g. ovarian, melanoma, breast,
colorectal)

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TILs

Front 12

TILs indicate a strong _______?

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Cellular response

Front 13

Tumor cells' primary mechanism of resistance?

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Decrease the expression of MHC-I

Front 14

Tumor cells secrete these cytokines to inhibit immunocytes?

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TGF-β and IL-10

Front 15

Four Immunity-Mediated Cancer Therapies?

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- immunostimulants (IFN-α, IL-2)
- cancer vaccines (in clinical trials)
- adoptive T-cell transfer (in clinical trials)
- monoclonal antibodies

Front 16

MOA of Interferon-alfa (IFN-α)?

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stimulates cytotoxic activity of CTLs, NK cells and macrophages
• upregulates MHC class 1 and other surface markers

Front 17

Major hurdle in adaptive T-cell transfer?

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establishment of stable population of reintroduced TILs in vivo

Front 18

What are the 5 classes of alkylating agents?

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1. nitrogen mustards
2. ethyleneimines
3. alkyl sulfonates
4. nitrosoureas
5. triazenes

Front 19

What are the 6 nitrogen mustard agents?

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cyclophosphamide, ifosfamide, chlorambucil, mechlorethamine,
melphalan, bendamustine

Front 20

What are the 2 most important nitrogen mustard agents?

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cyclophosphamide and ifosfamide

Front 21

Name the alkyle sulfonate alkylating agent?

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busulfan

Front 22

Name the triazene alkylating agents?

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dacarbazine and procarbazine

Front 23

Functional group of nitrogen mustard agents?

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bis-(2-chloroethyl)

Front 24

Mechanism of Alkylating Reaction of Nitrogen Mustard?

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Binding to the N7 position of guanine, causing interstrand cross-linakge

Front 25

Cyclophosphamide is used to treat?

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lymphoma, breast cancer, acute lymphocytic leukemia (ALL) and ovarian cancer

Front 26

Cyclophosphamide is a prodrug that makes the toxic metabolite _______?

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Acrolen

Front 27

Hemorrhagic cystitis caused by Cyclophosphamide can be counteracted by?

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Mesna (sulfonate) and diuresis

Front 28

Severe toxicity caused by Ifosfamide?

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CNS toxicity (crosses the BBB)

Front 29

Cell cycle effected by platinum complexes?

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Platinum complexes are cell-cycle non-specific

Front 30

Name the 3 platinum complexes?

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cisplatin, carboplatin and oxaliplatin

Front 31

Platinum complexes react with DNA forming intrastrand and interstrand cross-links, with N7 of guanine as the primary target. What is the favored cross-linking mechanism?

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Intrastrand

Front 32

Platinum complexes are cell-cycle non-specific, but they are most effective during ___phase

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S-phase

Front 33

Cisplatin causes nephrotoxicity that can be alleviated by?

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chloride diuresis and amifastine (Ethyol)

Front 34

pyrimidine analogs

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5-FU, capecitabine, cytarabine, gemcitabine, azacytidine,
decitabine

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purine analogs

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6-mercaptopurine, fludarabine, pentostatin, cladribine,
clofarabine, nelarabine

Front 36

Phase of cell cycle affected by antimetabolites?

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All antimetabolites are S-phase specific

Front 37

Primary MOA of MTX?

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inhibition of DHFR

Front 38

MTX toxicity can be rescued by?

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Leucovarin (folinic acid, N5-formyl FH4) a reduced folate coenzyme

Front 39

MOA of hydroxyurea?

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Inhibition of ribonucleotide reductase, thus blocking DNA synthesis

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MOA of 5-FU?

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blocks synthesis of TMP by inhibiting THYMIDYLATE synthase

Front 41

Agent that enhances the activity of 5-FU?

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Leucovarin

Front 42

MOA of purine analogs?

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inhibition of de novo synthesis of purine bases and nucleotides and as triphosphate derivatives incorporated into DNA strands

Front 43

MOA of vinca alkyloids?

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bind β-tubulin and block its ability to
polymerize with α-tubulin into microtubules

Front 44

Vinca alkyloid metabolism?

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extensive hepatic metabolism by CYP3A4 requiring dose reduction
for hepatic impairment

Front 45

Cell cycle phase affected by microtuble targeting agents?

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M-Phase

Front 46

MOA of taxanes (paclitaxel and docetaxel)?

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binding of β-tubulin subunit of microtubules and through the PROMOTION of microtubule polymerization

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Taxane moiety required for activity?

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C13 side chain on 8 member hexane ring

Front 48

Why does paclitaxel require a 50:50 Etoh to castor oil vehicle?

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Lipophilicity

Front 49

Method of correction for paclitexol lipophilicity?

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Abraxane: Paclitexol bound to albumin

Front 50

Topo-1 inhibitors?

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camptothecin analogs

Front 51

Camptothecin analogs?

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topotecan and, irinotecan

Front 52

Phase of cell cycle affected by topoisomerase inhibitors?

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S-phase

Front 53

Irinotecan (CPT-11) is a prodrug metabolized by hepatic
carboxylesterase to its active form ______.

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SN-38

Front 54

Topoisomerase II inhibitors?

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epipodophyllotoxins and anthracycline analogs

Front 55

Epipodophyllotoxins?

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Etopsode

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Anthracycline analogs?

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doxorubicin, daunorubicin, idarubicin
epirubicin, mitoxantrone

Front 57

MOA of TOPO-II inhibitors?

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- flat 4-RING system intercalates directly with DNA (GC rich) forming a complex with topoisomerase and DNA, causing double-stranded DNA breaks leading to apoptosis. Also produces free radicals that damage DNA.

Front 58

All anthracyclines are _____toxic?

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Cardiotoxic

Front 59

3 reasons for the cardiotoxicity of anthracyclines?

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-quinolone reduction producing superoxide
-no catalase in cardiac tissue
-high cardiac uptake of anthrcyclines

Front 60

Ion chelator used to reduce the carditoxicity of anthracyclines?

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Dexarazoxone

Front 61

Liposomal anthracycline designed to reduce cardiotoxicity?

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Doxorubicin Liposomal (DOXIL)

Front 62

MOA of all-trans retinoic acid?

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-displacement of the repressor of differentiation
-promotion of the degradation of the PML-RARa fusion protein

Front 63

MOA of arsenic trioxide?

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-displacement of the repressor of differentiation
-production of oxygen free radicals
-inhibition of angiogenesis

Front 64

Effect of ATR and ATRO on PML-RARa?

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ATO: Post translational modification of protein
ATRA: Replaces repressor and induces degradation (no post translational modification)

Front 65

Aromatase inhibitors?

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Anastrazole - Breast
Exemestane -Breast
Letrozole - Breast

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SERD?

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Fulvestrant -Breast

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SERMs?

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Raloxifene - Breast
Tamoxifen - Breast

Front 68

MOA of aromatase inhibitors?

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inhibits the enzyme aromatase, which is responsible for converting androgens to estrogens

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Androgen deprivation therapy?

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Goserelin acetate (Zoladex) is an injectable gonadotropin releasing hormone super-agonist (GnRH agonist), also known as a lutenizing hormone releasing hormone (LHRH) agonist. Goserelin acetate is used to suppress production of the sex hormones testosterone and oestrogen), particularly in the treatment of breast and prostate cancer.

Front 70

GnRH agonists?

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Leuprolide acetate and Goserelin acetate

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GnRH antagonist?

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Abarelix

Front 72

Androgen receptor blockers?

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Flutamide
Nilutamide
Bicalutamide

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Oral androgen deprivation agents?

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Flutamide
Nilutamide
Bicalutamide

Front 74

Rituximab?

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Anti-CD20 (Lymphoma)

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Alemtuzumab?

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Anti-CD52 (CLL)

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Gemtuzumab-Ozogamicin?

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Anti-CD33 + toxin (AML)

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Cetuximab?

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Anti-EGFR (colorectal cancer)

Front 78

Panitumumab?

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Anti-EGFR (colorectal cancer)

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Trastuzumab?

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Herceptin: anti-her2/neu (breast cancer)

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Bevacizumab?

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anti-VEGF (colorectal cancer)

Front 81

-ximab?

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Chimeric

Front 82

-umab?

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Humanized

Front 83

EGF-EGFR binding promotes?

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tumor cell growth and proliferation

Front 84

Suffix of tyrosine kinase inhibitors?

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-nib

Front 85

Tyrosine kinase inhibitors that inhibit ABL?

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Imatinib (CML, ALL)
Dastanib (Leukemia)
Nilotinib (Leukemia)

Front 86

Tyrosine kinase inhibitors that inhibit EGFR?

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Gefitinib (lung)
Erlotinib (lung)
Lapatinib (breast)

Front 87

Thalidomide complex?

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intercalates into DNA in G-C rich regions

Front 88

Bortezomib MOA?

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NF-Kb?