Aims of treatment of cancer

What are the 4 main aims of cancer treatment?

Prevention, cure/eradication of cancer, adjuvant therapy to prevent return of cancer and palliation to control cancer and prolong life

What does the cure rate of cancer depend on?

Early detection, effective systemic treatment, type of cancer, its chemo/hormaonl sensitivity and tumour bulk

What cancers are chemo sensitive so that even bulky metastases can be cured?

Leukaemia, lymphomas, testicular cancer

What is the type of treatment given as a first step before main treatment to shrink the tumour and improve local excision, also used to treat micro metastases ASAP, with the main treatment usually being surgery?

Neo-adjuvant therapy

What are examples of neo-adjuvant therapy?

Chemotherapy, radiation therapy and hormone therapy

What is the type of therapy which is additional treatment given after the first treatment for a primary tumour where the first treatment was aimed at eradicating the tumour and there is no evidence of distant metastases?

Adjuvant therapy

What does adjuvant therapy tend to target to improve tumour control and let the risk that cancer will come back?

Occult micrometastases

What are examples of adjuvant therapy?

Chemotherapy, radiation therapy, hormone therapy, targeted therapy or biologic therapy

What is the type of therapy that is chemotherapy administered with the goal of achieving a complete remission and preventing the recurrence of cancer?

Curative therapy

What is the type of therapy given without curative intent but simply to decrease tumour load and increase life expectancy?

Palliative therapy

What is the term to describe a biological drug that is very much like another biological drug that has been given a UK marketing authorisation, made fm living organisms but can differ slightly?

Biosimilar drug

What criteria must a drug fit to be classed as a biosimilar?

• Be as safe, work as well as and work in the same way as the reference

• Used in same way

• Same dose

• Same condition

• Have a UK marketing authorisation

• Can cost less than reference

What is the type of therapy focusing on modifying the immune system tor recognise the cancer being foreign to the body and needs to be attacked, proving some difficulty as the differences between healthy and cancer cells are hard to detect?

Cancer targeting immunotherapy

What is the role of the immune checkpoint in white blood cells?

Alerts cell to engage and fight or ignore and rest when it recognises a foreign substance

What does the immune cell checkpoint prevent?

Prevents immune system attacking normal cells

What is the role of checkpoint inhibitor drugs?

Block the molecules saying ignore and rest, allowing immune cells to attack cancer cells

What is an example of an immune checkpoint inhibitor that works by interfering with a molecular brake which usually inhibits the body’s system from attacking cancer cells?

PD-1 OR PD-L1 inhibitors - nivolumab for lung cancer, pembrolizumab for lung cancer and avelumab for renal cell cancer

What is the term to describe the study of how variances in the genome influences an individuals response to different drug treatments e.g., cancer drugs?

Pharmacogenomics

What is the genetic testing used to identify genetic variants that prevent people from metabolising fluoropyrimidine drugs e.g., 5-fluorouracil and capecitabine?

DYPD testing

How is DYPD testing done?

Blood test done to see if they carry the variant prior to starting chemotherapy

What is the benefit of DYPD testing?

Prevents toxicities and serious side effects for patients, allowing to look at alternative regimes

What is the treatment for cancer using patient’s own immune cells to fight cancer?

CAR-T therapy

How is CAR-T therapy carried out?

Doctors take T cells from patient’s blood and genetically modify in a lab, allowing better recognition and attacking of cancer cells, which are then placed back into the body

What type of cancers is CAR-T therapy used in?

Haematological cancers e.g., lymphomas, myelomas as a last resort