APHON Overview
biotherapy - Answer-modality of tx: agents that resemble body's own defense and surveillance systems.
can augment/modulate/restore host's immune response, direct antitumor activity, other biological
effects. side effects typically hypersensitivity rx
immune surveillance - Answer-tumor cells express abnormal tumor antigens on surface that can be
recognized/destroyed by immune system
natural killer cells - Answer-lymphocyte that recognizes/kills malignant cells
cytotoxic t cells - Answer-recognize tumor-assosiated antigens and kills cells
interferons - Answer-multiple moa's & produced w/ recombinant dna.
protein capable of protecting other cells from viral infections by interfering w/ viral replication.
family of glycoproteins include: antiviral, antiproliferative, potent immunomodulatory effects
cytokines - Answer-products of immune cells to enhance cytotoxic activity of cells and increase immune
response
alpha-interferon - Answer-leukocyte-derived. tx: hairy cell leukemia, melanoma, chronic myeloid
leukemia, follicular lymphoma, multiple myeloma, cutaneous t-cell lymphoma
beta-interferon - Answer-fibroblast-derived. tx MS
gamma-interferon - Answer-t-lymphocyte derived. tx chronic granulomatus disease
,interleukin-2 - Answer-produced by t-helper cells & stimulate growth/maturation of t-cell subsets,
cytotoxic t-cells, production of lymphokines & cytokines.
act as chemical signals b/w wbc's (revs up immune system)
retinoids - Answer-immunomodulators that facilitate differentiation & suppress proliferation of cancer
cells
all-trans retinoic acid (atra) - Answer-tx: aml, aml m3 subtype, apl
increase maturation of promyelocytic blasts and rapid resolution of coagulopathy r/t tx.
isotretinoin (accutane) - Answer-retinoid tx neuroblastoma.
have antitumor activity unknown moa. TERATOGENIC. male/female pt must register iPledge (fetal
exposure). can also affect hearing & vision
antibodies - Answer-proteins produced by b-lymphocytes. part of humoral immunity of adaptive system.
includes immunoglobulins (igG, igA, igM, igE, igD)
murine - Answer-mouse-derived MoAbs. pt develops human antimouse antibodies creating high risk of
hypersensitivity rx
end in -momab
Monoclonal antibodies - Answer-very specific. directed against single antigenic determinant on cell
surface causing antibody-dependent cellular toxicity, direct cell death, elimination of antigen/target cell
that expresses the antigen
low toxicity
-ximab - Answer-moab combo of human & mouse antibodies
,-zumab - Answer-moab humanized, small part of mouse antibody fused w/ human antibody
-umab - Answer-fully humanized moabs
chimeric moab - Answer-murine variable & human constant coupled using recombinant dna
purpose of moabs - Answer-attach low-dose radioisotopes to image residual disease. target chemo,
radiation, biotherapy to tumor
purge autologous bone marrow of cancer cells before transplant
selectively remove t cells responsible for gvhd from marrow prior to allogenic transplant
efficacy increased w/ chemo or radioactive substances
rituximab - Answer-tx relapsed/refractory b-cell lymphoma, cd20+, non-hodgkins lymphoma (w/ chop),
posttransplant lymphoproliferative d/o, & chronic gvhd
rituximab moa - Answer-act on CD20 antigen on surface of normal/malignant b lymphocytes and works
w/ immune system to induce b-cell lysis
radiopharmaceuticals - Answer-moabs that have radioactive source attached for cancer killing effect
ibritumomab tiuxetan (zevalin) - Answer-radiopharmaceutical tx relapse/refractory low-grade follicular
or transformed b-cell non-hodgkins lymphoma
rituximab + ibritumomab tiuxetan - Answer-target cd20 protein on b-cells. given prior to high dose of
radiation. causes increased toxicity and severe infusion rx
, tositumomab + iodine 131 tositumomab (bexxar) - Answer-tx cd20+ follicular non-hodgkin's lymphoma.
moa: recognizes marker and signals immune response then radioactive source locks on to moab,
delivers radiation directly to cd20 marked cells and kills lymphoma b-cells
hematopoietic growth factors - Answer-regulate different levels of hematopoietic cascade. aka colony
stimulating factors. primarily used for symptom management & expedited recovery from chemo-
induced bone marrow suppression
Colony Stimulating Factors - Answer-ptns that support hematopoiesis. decrease myelosuppression,
accelerate recovery from bmt, tx infections/parasitic diseases, help w/ pancytopenia
gcsf (filgrastim) - Answer-stimulates neutrophil colonies to enhance phagocytic activity and antibody-
dependent killing tendency. starting dose 5 mcg/kg/day
neulasta (pegfilgrastim) - Answer-long-acting gcsf. given 24h post chemo. given once per chemo cycle.
max dose is 6mg. kids <45kg dose is 0.1mg/kg
gm-csf (granulocyte macrophage csf; sargramostim) - Answer-given post bmt w/ non-hodgkins
lymphoma, all, hodgkins disease. dose: 250 mcg/kg/day. typically iv over 2h for 21 days. broader prod of
neutrophil & monocyte colonies
epoetin alfa - Answer-hormone produced naturally by kidneys in response to decrease O2 levels.
stimulates precursor cells in marrow to produce rbcs. dose 150 u/kg 3x/week
darbepoetin (aranesp) - Answer-long-acting epoetin. given weekly. dose 0.45mcg/kg sq. titrate dosing to
not get hgb >12
ESA APPRISE - Answer-risk management system associated w/ erythropoiesis-stimulating factors.
increase risk of tumor growth/progression, cv events, decreased survival rates when hgb >12
biotherapy - Answer-modality of tx: agents that resemble body's own defense and surveillance systems.
can augment/modulate/restore host's immune response, direct antitumor activity, other biological
effects. side effects typically hypersensitivity rx
immune surveillance - Answer-tumor cells express abnormal tumor antigens on surface that can be
recognized/destroyed by immune system
natural killer cells - Answer-lymphocyte that recognizes/kills malignant cells
cytotoxic t cells - Answer-recognize tumor-assosiated antigens and kills cells
interferons - Answer-multiple moa's & produced w/ recombinant dna.
protein capable of protecting other cells from viral infections by interfering w/ viral replication.
family of glycoproteins include: antiviral, antiproliferative, potent immunomodulatory effects
cytokines - Answer-products of immune cells to enhance cytotoxic activity of cells and increase immune
response
alpha-interferon - Answer-leukocyte-derived. tx: hairy cell leukemia, melanoma, chronic myeloid
leukemia, follicular lymphoma, multiple myeloma, cutaneous t-cell lymphoma
beta-interferon - Answer-fibroblast-derived. tx MS
gamma-interferon - Answer-t-lymphocyte derived. tx chronic granulomatus disease
,interleukin-2 - Answer-produced by t-helper cells & stimulate growth/maturation of t-cell subsets,
cytotoxic t-cells, production of lymphokines & cytokines.
act as chemical signals b/w wbc's (revs up immune system)
retinoids - Answer-immunomodulators that facilitate differentiation & suppress proliferation of cancer
cells
all-trans retinoic acid (atra) - Answer-tx: aml, aml m3 subtype, apl
increase maturation of promyelocytic blasts and rapid resolution of coagulopathy r/t tx.
isotretinoin (accutane) - Answer-retinoid tx neuroblastoma.
have antitumor activity unknown moa. TERATOGENIC. male/female pt must register iPledge (fetal
exposure). can also affect hearing & vision
antibodies - Answer-proteins produced by b-lymphocytes. part of humoral immunity of adaptive system.
includes immunoglobulins (igG, igA, igM, igE, igD)
murine - Answer-mouse-derived MoAbs. pt develops human antimouse antibodies creating high risk of
hypersensitivity rx
end in -momab
Monoclonal antibodies - Answer-very specific. directed against single antigenic determinant on cell
surface causing antibody-dependent cellular toxicity, direct cell death, elimination of antigen/target cell
that expresses the antigen
low toxicity
-ximab - Answer-moab combo of human & mouse antibodies
,-zumab - Answer-moab humanized, small part of mouse antibody fused w/ human antibody
-umab - Answer-fully humanized moabs
chimeric moab - Answer-murine variable & human constant coupled using recombinant dna
purpose of moabs - Answer-attach low-dose radioisotopes to image residual disease. target chemo,
radiation, biotherapy to tumor
purge autologous bone marrow of cancer cells before transplant
selectively remove t cells responsible for gvhd from marrow prior to allogenic transplant
efficacy increased w/ chemo or radioactive substances
rituximab - Answer-tx relapsed/refractory b-cell lymphoma, cd20+, non-hodgkins lymphoma (w/ chop),
posttransplant lymphoproliferative d/o, & chronic gvhd
rituximab moa - Answer-act on CD20 antigen on surface of normal/malignant b lymphocytes and works
w/ immune system to induce b-cell lysis
radiopharmaceuticals - Answer-moabs that have radioactive source attached for cancer killing effect
ibritumomab tiuxetan (zevalin) - Answer-radiopharmaceutical tx relapse/refractory low-grade follicular
or transformed b-cell non-hodgkins lymphoma
rituximab + ibritumomab tiuxetan - Answer-target cd20 protein on b-cells. given prior to high dose of
radiation. causes increased toxicity and severe infusion rx
, tositumomab + iodine 131 tositumomab (bexxar) - Answer-tx cd20+ follicular non-hodgkin's lymphoma.
moa: recognizes marker and signals immune response then radioactive source locks on to moab,
delivers radiation directly to cd20 marked cells and kills lymphoma b-cells
hematopoietic growth factors - Answer-regulate different levels of hematopoietic cascade. aka colony
stimulating factors. primarily used for symptom management & expedited recovery from chemo-
induced bone marrow suppression
Colony Stimulating Factors - Answer-ptns that support hematopoiesis. decrease myelosuppression,
accelerate recovery from bmt, tx infections/parasitic diseases, help w/ pancytopenia
gcsf (filgrastim) - Answer-stimulates neutrophil colonies to enhance phagocytic activity and antibody-
dependent killing tendency. starting dose 5 mcg/kg/day
neulasta (pegfilgrastim) - Answer-long-acting gcsf. given 24h post chemo. given once per chemo cycle.
max dose is 6mg. kids <45kg dose is 0.1mg/kg
gm-csf (granulocyte macrophage csf; sargramostim) - Answer-given post bmt w/ non-hodgkins
lymphoma, all, hodgkins disease. dose: 250 mcg/kg/day. typically iv over 2h for 21 days. broader prod of
neutrophil & monocyte colonies
epoetin alfa - Answer-hormone produced naturally by kidneys in response to decrease O2 levels.
stimulates precursor cells in marrow to produce rbcs. dose 150 u/kg 3x/week
darbepoetin (aranesp) - Answer-long-acting epoetin. given weekly. dose 0.45mcg/kg sq. titrate dosing to
not get hgb >12
ESA APPRISE - Answer-risk management system associated w/ erythropoiesis-stimulating factors.
increase risk of tumor growth/progression, cv events, decreased survival rates when hgb >12
