Immunotherapy Flashcards Preview

Hematology, oncology > Immunotherapy > Flashcards

Flashcards in Immunotherapy Deck (32)
Loading flashcards...
1
Q

AE’s of checkpoint inhibitors

A
  • autoimmune encephalitis
  • peripheral neuropathy
  • nephritis/renal failure
  • cardiotoxicity (anything but high risk for conduction abnormalities)
  • type 1 diabetes (irreversible)
  • hypophysitis
  • rash
  • autoimmmune hepatitis
  • hypo/hyperthyroidism
  • colitis (diarrhea, abdominal pain, GI bleeding). ***Virtually any organ can be subject to autoimmunity. There all diagnosis of exclusion, must rule out infection too. Lung toxicity can be deadly if not identified early enough.
  • Most common – skin rash, pruritus, colon SE’s.
2
Q

Rash in immune checkpoint inhibitors

A

highly variable, includes SJS and bullous pemphigoid.

3
Q

When to hold immunotherapy

A

most grade 2 toxicities, grade 3 generally

4
Q

Deaths from immune checkpoint inhibitors?

A

very rare but have been documented.

5
Q

correlation of toxicity and outcome

A

*Toxicity does not correlate to outcome, There is some data that if you develop toxicity, you have a higher survival rate (immune system activation).

6
Q

Elderly population and immunotherapy

A

Data suggests they do just as well, despite immune system senescence (but this is for elderly people with high PS).

7
Q

Can HIV patients be treated?

A

Yes, but need HIV ID specialist.

8
Q

Can you treat organ transplant recipient?

A

Yes, but about 50% have organ rejection

9
Q

Can you restart immune checkpoint blockade after AE?

A

Depends on severity of AE, but data is mixed on efficacy (a lot of people seem to remain in CR).

10
Q

Can you treat patients with autoimmune disease?

A

You can but chance of flair are higher.

11
Q

How to manage most SE’s of checkpoint inhibitors

A

→ steroids for generally at least 4 weeks + hold therapy (a few you can continue)

12
Q

Management of autoimmune hepatitis as SE from checkpoint inhibitors

A

mycophenolate, NOT infliximab (hepatotoxic)

13
Q

steroid taper for managing AE’s

A

4-6 weeks

14
Q

Patients on immune checkpoint inhibitors also need

A

PPI + bactrim

15
Q

general physiologic effect of immune system activation

A

immune system activation commonly causes an inflammatory response in normal tissue.

16
Q

immune-related colitis prognosis and management

A

can be fatal, early diagnosis and intervention is critical. IV steroids (bioavailability).

17
Q

ipilimumab MOA

A

CTLA4 inhibitor

18
Q

tocilizumab MOA

A

biologic, Anti-IL-6 receptor monoclonal antibody

19
Q

etanercept MOA

A

biologic, recombinant TNF receptor linked to IgG1 Fc portion

20
Q

what are tumor infiltrating lymphocytes (TILs)?

A

Lymphocytes within tumor, that are then amplified and transfused back into patient. Good evidence for melanoma, and being studied for other cancer types.

21
Q

How do you choose among PD-L1 CPI’s?

A

Basically on scheduling/dosing frequency (pembro ideal because it can be given every 6 weeks)

22
Q

Best metric for predicting response to PD1/PDL1 CPI’s

A

Still unclear. PD-L1 expression is the most widely used currently. BUT PD-L1 may not be best marker (some patients respond well without high expression). Tumor mutational burden may be better.

23
Q

How is TMB measured?

A

NGS

24
Q

Pembro mechanism of action

A

monoclonal ab that binds to the PD-1 receptor on T-cells –> this blocks PD-1 ligands (PD-L1 and PD-L2) from binding –> Blocking the PD-1 pathway inhibits the negative immune regulation caused by PD-1 receptor signaling (Hamid 2013) –> this reverses T-cell suppression and induces antitumor responses

25
Q

What are the checkpoint inhibitors?

A
  • CTLA-4

- PD-1 or PD-L1

26
Q

Contraindications to immunotherapy

A

1) connective tissue disease
2) autoimmune disease

27
Q

Colitis incidence higher with which CPIs

A

CTLA-4 inhibitors

28
Q

Reversibility of CPI toxicity

A

Endocrine toxicity is generally irreversible, the others are reversible

29
Q

Incidence of infusion reactions with CPIs

A

rare.

30
Q

Time course with checkpoint inhibitor toxicity

A

Toxicities can also happen a month after you finish drug, or even longer. Time course varies depending on organ (skin earlier, pulm later, GI earlier).

31
Q

IRAE means

A

Immune related adverse events.

32
Q

efficacy of immunotherapy in patients on steroids

A
  • in melanoma literature, it hasn’t been associated with decreased efficacy
  • however, there is data showing decreased efficacy in patients taking steroids prior to starting immunotherapy

Decks in Hematology, oncology Class (218):