Advanced Cancer Treatments

Precision Medicine: uses a person’s genetic profile, lifestyle and environmental factors to inform health care decisions. Goal is to provide more treatments with fewer side effects.

Pharmacogenetics: The study of the role that an individuals genetic makeup plays in how well a medicine works, as well as what side effects are most likely.

SNP(single nucleotide polymorphism): looks at the neucleotide at a specific mutation. Specific places in DNA that were identified affects what were studying. SNP Profile: SNP someone has

Haplotype: All combinations you have at the SNP. These combinations indicate how a patient might react to medications, flavors, etc.. Sequence DNA to find haplotype

Thiopurines: Thiopurines work by interfering with DNA replication, and therefore, stop cancer cells from growing and spreading. Patients need enough of the drug to be effective, but not too much to cause damage to healthy cells.  If TPMT enzyme levels are low, thiopurines can build up in the body and cause side effects, such as bone marrow damage, lowering the production of blood cells.

Explain why the patient with the lowest level of TPMT enzyme has the greatest number of side effects when exposed to a drug containing thiopurine.

  • The patient with the lowest level of the TPMT enzyme has the greatest number of side effects when exposed to a drug containing thiopurine, because when someone is exposed to such a drug it can lead to an overabundance or excess amount of thiopurine in the body, causing them to have the most amount of side effects. If the patient doesnt have any thiopurine, then TMPT can’t be broken down causing the immune system to be suppressed.

  • Thiopurine methyltransferase (TPMT) is a cytoplasmic transmethylase present in prokaryotes and eukaryotes.

  • Scientists have determined that TMPT is an enzyme produced by the body and is involved in the metabolism and breakdown of thiopurines.

Nanotechnology: understanding and control over matter at dimensions between approximately one and one hundred nanometers. Nanoshells: absorb light and create extreme heat that kills nearby cells

Nanomedicine- use of nanotechnology in medicine.

Quantum dots: Quantum dots bind to specific DNA regions.  When exposed to UV light, emit different colors of light.

5 purposes of clinical trials: 1. New treatment 2. experiment drugs 3. new surgery/radiation techniques 4. diagnostic approaches 5. prevention techniques

Clinical Trial Phases.

  1. evalute safety, side effects, and safe dosage , <100 people

  2. evaluate safety, side effects, narrow in on dosage, up to 200 people

  3. determine effectiveness and side effects, 1000-3000 people

  4. collect additional info once it reaches the market, risks, benefits, optimal use

Types of clinical trials: Controlled, Randomized, Double blind

Controlled: 1 groups gets treatment, the other doesnt

Randomized: groups are randomly chosen

Double blind: neither patient or researcher know who gets what. important so no bias is used or had

Single blind: reseacher knows, but subject doesnt

Open Trials: Reseachers and subjects know which treatment is given, more prone to errors and biases, could be important for surgery

Factorial Trials: testing medicines in combinations, test groups, ex. no medicine, medicine a, medicine b, medicine a and b. Can be difficult to interpert resuts

Crossover Trials: test 2 treatments, order of treatments is different, ex. treatment a then b or treatment b then a

Orphan Drug Trials: drugs to treat rare diseases <200,000 americsns, tested on small number of patients who are very sick

CLINICAL TRIAL SAFETY:

-trials must be approved by the IRB(institutional review board)

-review board: are the trials worthy? are they ethial? Monitors the trials, stops if necessary, work submitted to FDA(food and drug admin) for final approval

Cancer & Radiation: destroy cancer cells, but have many side effects

New treatments(nanotech or immuntherapy): offer promises for cancer prevention, diagnosis and treatment

How immunotherapy is used to treat cancer?

-stimulating/boosting immune system, creating things in the lab that are immune system components to improve or restore how the immune system works to fight cancer (ex-antibodies), cancer cells can be difficult to recognize since cancer develops from normal cells. Proteins in the cells can be used to find cancerous cells.

TYPES OF IMMUNOTHERAPY:

Monocoloal antibodies: lab made antibodies. Monoclonal antibodies trigger an immune response that can destroy the outer wall or membrane of a cancer cell.

Checkpoint inhibitors: check point molecules on cancer cells bind to checkpoint receptors on immune cells preventing an immune response, check point inhibitors prevent this binding so immune cells can be activaited.Normally checkpoint receptors help an immune cell tell the difference between a self and nonself cell. Cancer cells can bind to these though and turn off the immune cell, preventing the immune system from launching an attack on the cancerous cells

Example of checkpoint inhibitors are monoclonal antibodies

A serious side effect is turning off a safeguard, preventing immune cells from responding against self cells.  This can cause the immune system to start attacking self cells

Interferons:chemical/pills that can boost immune system

Interleukins: boosts immune system

Oncolytic virus therapy: uses viruses to target and destroy cancer cells

Cancer vaccines: vaccines that destroy cancer cells

Precision oncology- identifying molecular fingerprints to target specific tissues (lung, liver, etc) based on where the cancer is located

Cancer immunotherapy- training the immune system or enhancing the immune system’s response to cancer

Pharmacogenomics- determining which medication is best based on genetics

Rare diseases- developing treatment for rare diseases (estimated that 25-30 million Americans have rare genetic diseases-

What are the ethical implications to consider when developing precision medicine?

-consent from the patient, cost and avaliability of equipiment, patient privacy,