Immune Response and Cancer Treatments Quiz

Lab Tests (Blood Tests)

• Complete blood count (CBC) assesses different blood cell types, aiding in blood cancer detection (e.g., leukemia, lymphoma, myeloma). Bone marrow biopsy may confirm blood cancer.
• Blood protein staining tests for abnormal proteins (antibodies), supporting lymphoma, chronic lymphocytic leukemia, and multiple myeloma diagnoses.
• Tumor marker tests identify abnormal proteins (e.g., CA-125 for ovarian cancer), potentially indicating cancer presence and type.
• Circulating tumor cell (CTC) tests examine cancer cells in the bloodstream. These tests are less frequent.

Complete Blood Count (CBC)

• Red blood cell (RBC) tests include counts of RBCs, hemoglobin, hematocrit, and reticulocytes (immature RBCs). These data provide information about oxygen-carrying capacity and blood's composition.
• White blood cell (WBC) tests and differentials count various WBCs (e.g., monocytes, lymphocytes, neutrophils, basophils, eosinophils) characterizing immune cell types and function.
• Platelet (PLT) analysis includes counts, mean platelet volume, and distribution width evaluating platelet size and uniformity, crucial for blood clotting.

Blood Protein Staining

• Serum electrophoresis assesses the amount and types of proteins in blood aiding diagnosis of lymphoma, chronic lymphocytic leukemia, and multiple myeloma, highlighting abnormalities.
• The method analyzes protein zones like albumin, alpha-1 antitrypsin, alpha-2 macroglobulin, beta-1 & beta-2 transferrin, and gamma globulin, providing further insights into potential cancer types and severity.

Tumor Marker Tests

• Common tumor markers are available from cancer.gov (link provided).
• CA-125 is used in blood tests for ovarian cancer diagnosis and treatment.
• CD25 is linked to non-Hodgkin lymphomas, and targeted therapy.
• EGFR is used in non-small-cell lung cancer treatment and prognosis.
• Estrogen receptor levels are evaluated in breast cancer for hormone therapy and targeted therapies.

CA-125 & Ovarian Cancer

• Cancer antigen 125 (CA-125) is a glycoprotein with molecular weight greater than 200 kD, detected via immunoassay (testing method).
• Normal CA-125 levels are below 46 U/mL in blood; elevated levels might suggest ovarian cancer, endometriosis, liver disease, menstruation, or pregnancy. Uterine fibroids could also elevate CA-125.

70-Gene Signature (70-GS, MammaPrint)

• The 70-gene signature test assesses 70 different genes in breast cancer tissue (less than three infected lymph nodes), predicting metastasis and recurrence and aiding breast cancer treatment.

Circulating Tumor Cell (CTC) Tests

• CTC tests are performed for breast, colorectal, and prostate cancers.
• CellSearch is a form of liquid biopsy developed and FDA-approved for these tests.
• The tests use ferrofluid nanoparticle-based technology and are suggested as a helpful technique (video link provided).

Cancer Diagnostic Imaging

• Diagnostic imaging techniques include breast mammograms, CT scans, PET scans, and MRI scans. These methods provide visual representations of body structures, revealing potential abnormalities crucial in diagnosis, staging, and treatment planning.

Breast Mammogram

• Breast mammogram is a low-dose X-ray imaging technique used to create images of two breasts to detect abnormal areas.
• This method is used for breast cancer screening.

CT, PET, and MRI

• Computed Tomography (CT) uses X-rays from various angles to create cross-sectional images.
• Positron Emission Tomography (PET) utilizes a radioactive tracer (like fluorodeoxyglucose) for imaging cellular activity in tumors. This information helps to identify malignant regions.
• Magnetic Resonance Imaging (MRI) utilizes magnetism and radio waves offering detailed images of inner structures without X-ray exposure, crucial for soft-tissue examination and cancer diagnosis.

Cancer Biopsy

• Biopsy is the primary method for diagnosing most types of cancer involving removal and analysis of tissue samples from a patient, assisting in cancer diagnosis.
• Different types of biopsies include bone marrow, endoscopic, needle, skin, surgical approaches for various applications.
• The results of biopsy analyses are used for confirming cancer, identifying the type and grade (characterization), and identifying markers for targeted therapies.

Surgery

• Surgery involves complete or partial tumor removal (debulking) to ease cancer symptoms, potentially improving survival.
• Different surgical types include minimally invasive, robotic, open, cryosurgery (using liquid nitrogen), and laser surgery, each suited for different cancer types. Hyperthermia (radiofrequency ablation) is another surgical technique using temperatures to destroy tissue.

Radiation Therapy

• Radiation therapy uses high doses of radiation to eliminate cancer cells and shrink tumors—this is crucial in treatment and palliative care.
• Radiation techniques include external beam (photons, protons, electrons), 3D conformal radiation therapy (3D-CRT), and intensity-modulated radiotherapy (IMRT). Internal radiation therapy uses radioactive material inside the body (brachytherapy, radioisotope therapy, radioimmunotherapy, and radioembolization).

3D Conformal Radiation Therapy (3D-CRT)

• 3D-CRT utilizes CT scans for creating accurate 3D models of tumors and surrounding organs to precisely target radiation beams. This helps in sparing healthy tissue and concentrating the treatment on cancerous areas.

Intensity-Modulated Radiotherapy (IMRT)

• IMRT uses CT scans to create 3D models for precise radiation targeting. Advanced software divides radiation beams into small beamlets, enabling finer control and higher precision for better treatment outcomes while reducing damage to surrounding healthy tissues.

Internal Radiation Therapy

• Internal radiotherapy uses sealed containers of radioactive material (brachytherapy), radioactive isotopes (such as I-131 for thyroid cancer), and radioimmunotherapy (a combination of radioisotopes and antibodies) for treating tumors, while radioembolization uses radioactive beads to reduce blood supply to organs.

Chemotherapy

• Chemotherapy is a widely used cancer treatment that destroys cancer cells, used alone or with other therapies that can often be used following primary treatment steps like surgery or radiotherapy.
• This method often targets cell growth or DNA and is used to eliminate micro-metastasis, prevent recurrence, or prepare patients before further treatment steps like surgery or radiotherapy.

Chemotherapy Types

• Several categories exist for cancer chemotherapy (e.g., DNA-damaging agents, alkylating agents, antimetabolites, taxanes and vinca alkaloids, antitumor antibiotics, DNA-repair enzyme inhibitors, and PARP inhibitors) based on their action mechanisms and applications.

Alkylating Agents

• A wide range of alkylating agents covers nitrogen mustards (e.g., melphalan, cyclophosphamide, ifosfamide, chlorambucil, estramustine).
• Nitrosoureas (e.g., carmustine, lomustine, nimustine, streptozocin) also belong in this category.
• Platinum drugs (e.g., carboplatin, cisplatin, oxaliplatin) and miscellaneous agents (e.g., busulfan, procarbazine) complete this broad category of chemotherapy drugs and their applications.

Platinum Alkylating Agents

• Platinum alkylating agents such as cisplatin, carboplatin, and oxaliplatin work by alkylating and crosslinking DNA.

Busulfan

• Busulfan removes a mesylate group to create a reactive form, affecting DNA molecules. It leads to an effective treatment for chronic myelogenous leukemia.

Procarbazine

• Procarbazine forms a methyldiazonium ion and methyl cation, affecting DNA, preventing protein, RNA, and DNA synthesis and contributing to the treatment of Hodgkin's lymphomas (stages III and IV) and certain non-Hodgkin's lymphomas and gliomas).

Antimetabolites

• Antimetabolites interfere with the synthesis of cellular metabolites, including pyrimidine and purine analogues, folate analogues. Specific examples include 5-fluorouracil (5-FU), capecitabine, gemcitabine, cytarabine, and azacitidine.

Antimetabolites: MOA (Mechanism of Action)

• Cytarabine inhibits the conversion of cytidylic acid into 2'-deoxycytidylic acid, impedes DNA-dependent DNA polymerase and causes miscoding, and effectively targets cells in the S-phase.

Antimitotics (Taxanes)

• Antimitotics, specifically taxanes, like Paclitaxel and Docetaxel, are extracted from the Pacific yew tree, target free tubulin, form stable microtubules, and inhibit their disassembly.
• This method affects cell division, targeting breast, lung, ovarian, and other cancer types.

Vinca Alkaloids

• Vinca alkaloids are a different class of antimitotics that prevent microtube polymerization.
• They include vinblastine, vincristine, vindesine, and vinorelbine.
• These agents are used to treat Hodgkin's lymphoma, non-small cell lung cancer, bladder cancer, and melanoma due to their impact on cell division.

Antitumor Antibiotics

• Antitumor antibiotics, such as anthracyclines (daunorubicin, doxorubicin, epirubicin, idarubicin, and mitoxantrone), are intercalating agents intervening with DNA. This property is linked to their anti-cancer properties.

Mechanism of Action (MOA) for Anthracyclines

• Anthracyclines intercalate with DNA molecules perpendicularly, leading to DNA cleavage and inducing cell death.

PARP Inhibitors

• PARP inhibitors, such as olaparib, rucaparib, niraparib, iniparib, and talazoparib, target PARP (poly (ADP-ribose) polymerase), an enzyme involved in DNA repair.
• Overexpression of PARP is linked to many cancer types.
• These inhibitors aim to block DNA repair, triggering cancer cell death.

Targeted Therapy

• Targeted therapy aims to slow cancer growth, destroy cancer cells, and reduce symptoms by targeting specific molecules or pathways involved in cancer growth.
• Some targeted therapy agents include small molecule agents and monoclonal antibodies.

Targeted Therapy Agents

• Several classes of targeted therapy agents include tyrosine kinase inhibitors (TKIs) such as imatinib, gefitinib, ibrutinib, and others; monoclonal antibodies such as trastuzumab, pertuzumab, T-DM1, zenocutuzumab, Bevacizumab, Rituximab, and others; apoptosis-inducing agents such as bortezomib, oblimersen and other agents; and angiogenesis inhibitors such as Bevacizumab and Sunitinib and various others.

Tyrosine Kinase Inhibitors (TKIs)

• Tyrosine kinase (TK) domain is present in growth factor receptors (e.g., EGFR, VEGFR), and signaling protein kinases.
• TKIs and their corresponding drugs target and affect specific elements identified in cancers.

Imatinib

• Imatinib treats chronic myelogenous leukemia (CML) and acute lymphocytic leukemia (ALL) by inhibiting BCR-ABL tyrosine kinase. It's important to remember it targets cells with specific abnormalities (BCR-ABL positive).

Gefitinib

• Gefitinib targets the epidermal growth factor receptor (EGFR) and signalling pathways relating to DNA synthesis, proliferation, migration and survival.
• It is primarily prescribed to treat non-small cell lung cancer (NSCLC) that relates to specific mutations (exon 19 deletion or exon 21 L858R mutation).

Monoclonal Antibodies (e.g., Trastuzumab, Pertuzumab, T-DM1)

• Monoclonal antibodies such as trastuzumab and pertuzumab target Her2/neu/ErbB2 receptor in breast cancer.
• They bind to specific domains in the Her2 protein, including subdomain II.
• This blocking inhibits Her2/neu/ErbB2 receptor signalling, reducing cell growth and metastasis.
• The results of the treatment can vary.

T-DM1 (ado-trastuzumab emtansine)

• T-DM1 is a conjugate of trastuzumab and emtansine used in the treatment of HER2-positive metastatic breast cancer.
• Emtansine is a component that generates cytotoxic effects within cancer cells.

Apoptosis-inducing Agents (e.g., Bortezomib)

• Agents such as Bortezomib are proteasome inhibitors and apoptosis-inducing therapy agents used to treat multiple myeloma and certain lymphomas because they interrupt processes or proteins linked with apoptosis or cellular death.

Angiogenesis Inhibitors (e.g., Bevacizumab)

• Agents such as Bevacizumab are monoclonal antibodies that block the vascular endothelial growth factor (VEGF) proteins and their receptors.
• This interference prevents blood vessel formation, starving cancerous cells of the nutrients and oxygen they need.

Sunitinib

• Sunitinib is a multiple-targeted tyrosine kinase inhibitor, blocking VEGF, platelet-derived growth factor receptor (PDGFR), colony-stimulating factor receptor (CSF1R), and tyrosine-protein kinase KIT.

Immunotherapy

• Immunotherapy strategies boost the body's immune system to fight cancer by targeting processes like immune checkpoints (PD-1 and PD-L1), T-cell transfer therapy, monoclonal antibodies, and treatment vaccines.

Immune Checkpoint Inhibitors (PD-1 and PD-L1 Inhibitors)

• Immune checkpoint inhibitors (e.g., pembrolizumab, nivolumab, cemiplimab, atezolizumab, avelumab, and durvalumab) target the PD-1 pathway, which in cancers reduces the response of T-cells to kill tumour cells.

Hormonal Therapies (e.g., Tamoxifen)

• Hormonal therapies use hormones to target specific receptors such as ER (estrogen receptor) or PR (progesterone receptors), stopping or interfering to block the cancer growth processes. Tamoxifen targets the estrogen receptor.