Hematology & Oncology Pharmacotherapy

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S phase?

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Synthesis

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Gap 0?

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Quiescent/senescent state: A resting phase where the cell has left the cycle and has stopped dividing

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Gap 1 (G1)?

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Cells increase in size in Gap 1. The G1 checkpoint control mechanism ensures that everything is ready for DNA synthesis.

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DNA replication occurs during this phase?

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S phase of interphase

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G2 (Gap 2)?

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During the gap between DNA synthesis and mitosis, the cell will continue to grow. The G2 checkpoint control mechanism ensures that everything is ready to enter the M (mitosis) phase and divide

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M phase?

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Mitosis. Cell growth stops at this stage and cellular energy is focused on the orderly division into two daughter cells. A checkpoint in the middle of mitosis (Metaphase Checkpoint) ensures that the cell is ready to complete cell division

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Cancer?

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Uncontrolled proliferation of cells & the cell cycle

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Cancer and the G0 phase?

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The regulatory checkpoints are not active in cancer cells, leading to continuous replication

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Neoadjuvant chemotherapy?

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Preoperative treatment designed to shrink primary tumors and lessen the area of local therapy (surgery or radiotherapy)

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Adjuvant chemotherapy?

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Postoperative treatment used when there is little evidence of cancer present, but there is risk of recurrence.

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Immunotherapy options in cancer treatment?

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-Immunostimulants
-Adaptive T-cell transfer (in trials)
-Vaccines (in trials)

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Target of M-phase specific antineoplastic agents?

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Microtubules of the cancer cell

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Phase non-specific antineoplastic agents?

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Mainly the alkylating agents that affect the DNA

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50% of all cancers have this mechanism of resistance?

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p53 mutation that causes defective checkpoint function and interference with apoptosis

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Antineoplastic agents most likely to be effected by a resistance mechanism that decreases the drug's activity?

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Cytosine arabinoside, fludarabine, cladribine and methotrexate.

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Antineoplastic agents most likely to be effected by a resistance mechanism that alters the drug target?

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Etopside, doxirubicin and gleevec.

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Antineoplastic agents most likely to be effected by a resistance mechanism that alters the drug target?

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Etopside, doxirubicin, vinca alkaloids, paclitaxel and topotecan.

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Can the immune system recognize and destroy cancer cells?

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Yes, but slow and difficult. Cancer needs to be a strong antigen to ellicit a response and immune system needs to be very effective

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Immunocompromised and organ transplant patients are at increased risk of these cancer types?

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Cancers of viral origin:
Kaposi’s sarcoma (HHV-8)
Hodgkin’s lymphoma (EBV)
cervical cancer (HPV)
liver cancer (HBV)

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Effector cells of the innate immune system include?

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natural killer (NK) cells, granulocytes,
monocytes/macrophages and mast cells

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Effector cells of the humoral adaptive immune response?

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helper T cells (TH, CD4 ) and B-cells

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Effector cells of the cellular adaptive immune response?

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Helper T-cells (TH) and cytotoxic T- cells (TC, CTL and CD8)

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The compliment system is made up of?

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Plasma proteins

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Compliment functions?

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opsonize pathogens, recruit inflammatory and immunocompetent cells, kill certain bacteria

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antibody : antigen complexes activate the complement system by?

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direct binding

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The formation of membrane-attacking complexes results in?

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pores in cell membranes

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Complement receptors mediate ingestion of complement-bound proteins by _____________?

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phagocytes

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Hematopoietic stem cells differentiate into?

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Myeloid an Lymphoid progenitors

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Mast cells, granulocytes and macrophages originate from ______ stem cells.

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Myeloid

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B-cells, T-cells, NK-cells, and dendritic cells (main antigen-presenting cells, APC) originate from______stem cells.

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Lymphoid stem cells

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_____ cells are likely to be the main effector cells during the innate immune response to cancer cells.

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NK cells

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NK Cell-Mediated Innate Immunity is activated by or other cytokines, resulting in the releases of cytotoxic granules (____ and ____) that induce apoptosis

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interferon-γ, perforin and granzymes

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In the humoral immune response, professional antigen-presenting cells (APCs) are?

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Dendritic cells and macrophages

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In the humoral immune response, ingested proteins are digested into oligopeptides ( ____)
and loaded onto _________.

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18-22aa, MHC class II molecules

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The role MHC class II molecules in the humoral immune response?

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present the tumor antigens

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In the humoral immune response, activation of helper T-cells will lead to activation of B-cells, which then _______.

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produce antibodies

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Which portion of an antibody binds to antigens?

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The variable region binds to antigens

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Which portion of antibodies is recognized by receptors on NK cells and phagocytes.

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FC portion, recognized by FC receptors

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In cell mediated adaptive immunity, intracellular antigens are displayed by?

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MHC Class I molecules

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Cell-Mediated Adaptive Immunity does not involve ______?

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Dendritic cells

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Tumor cells constitutively display _______ on the cell surface

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Their own antigen

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On tumor cells, oligopeptide fragments _____ complexed with MHC class I molecules are displayed by ____cell types

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8-11aa and mast cells

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tumor-______ antigens (TSA)
not expressed by normal cells.

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tumor-specific antigens

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tumor- _______ antigens (TAA)
are also expressed by normal cells at certain differentiation stages, in certain cell types or at lower levels

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tumor-associated antigens

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Immunosurveillance is?

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the ability of immune system to detect tumor cells and destroy them

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Tumor Infiltrating Lymphocytes (TILs) are mainly?

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cytotoxic T cells (Tc, CTLs, CD8+)

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There is a strong correlation between the presence of TILs and the survival of patients with certain cancers, including:

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ovarian, melanoma, breast and
colorectal cancers

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Regulatory T Cells (Tregs) are recruited by tumor cells via chemokine
(CCL22) secretion. This inhibits both Th _______cells and Tc _______ cells.

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(CD4+ and CD25-) and (CTL, CD8+ CD25-) cells

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Regulatory T-cells can affect effector T-cells b/c they are both _________.

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CD4+ & CD25+

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Cancer cells evade the immune response by suppressing the cell surface display of?

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Tumor antigens on MHC Class I molecules

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Cancer cells also suppress the immune response by suppressing immunocytes through?

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• induction of immunocyte apoptosis
• secretion of cytokines (TGF-β, IL-10)

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Immunity-Mediated Cancer Therapy involves these 4 methods?

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

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Immunity-Mediated Cancer Therapy g produced in E. Coli using recombinant DNA technology?

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Interferon-alfa (IFN-α)

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MOA of Interferon-alfa (IFN-α)?

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

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Intron A?

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Interferon-alfa 2B

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Intron A is dosed at 2-30 million units/m2, sq, im or iv, daily or every other day for the following cancer types:

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melanoma and lymphoma

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The clinical toxicities of Intron A include?

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flu-like symptoms (fever, chills, headache) and myelosuppression

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Interferon-alfa 2A?

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Roferon-A

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therapeutic uses of
Interferon-alfa 2A (Roferon-A®):
dosing: 9 million units/m2 /day, ____ for cancer types:

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SQ, for CML (leukemia) and melanoma

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Clinical toxicities of Roferon-A?

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flu-like symptoms (fever, chills, headache) and myelosuppression

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ALL?

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Acute lymphoblastic leukemia

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CLL?

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Chronic lymphocytic leukemia

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AML?

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Acute myelogenous leukemia

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CML?

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Chronic myelogenous leukemia

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HCL?

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Hairy cell leukemia

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Interleukin 2?

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IL-2, Aldesleukin, PROLEUKIN

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Source and structure of recombinant IL-2?

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Produced in E. Coli using recombinant DNA technology
• 15.3 KD protein

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Aldesleukin, PROLEUKIN MOA?

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stimulates proliferation & growth of IL-2-dependent cells
• enhances cytotoxic activity of CTLs and NK cells

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therapeutic uses of Aldesleukin, PROLEUKIN:
dosing: 600,000 – 720,000 ___ IU/kg, every 8 hours up to 5 days
for ________.
cancer types: , renal

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IV, for melanoma and renal cancers

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Clinical toxicities of Aldesleukin, PROLEUKIN?

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Cardio toxicity

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Cancer vaccines aim to stimulate the ______ arm of the immune
system directly in vivo.

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Adaptive

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Antigen-loaded dendritic cells represent?

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intensive ongoing research to develop cancer vaccines to TREAT cancers

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Adaptive T-cell transfer has achieved partial response in some patients with metastatic _______.

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Melanoma

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Antibody-dependent cellular cytotoxicity (ADCC) is the toxicity mediated by _______.

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NK cells

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Complement-dependent cytotoxicity (CDC) involves ________?

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Formation of MAC complex that will lead to cell death

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Macrophages can be _____ and _____?

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Antigen presenting cells and cytotoxic cells

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Killer proteins of the innate immune system are_____?

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Compliment