Devita, Hellman, and Rosenberg's Cancer

LWBK1006-09 LWW-Govindan-Review December 12, 2011 18:51

112 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Answer 9.12. The answer is A.

The results of treatment with cancer vaccines have been very low. Of

1306 vaccine treatments, the objective response rate is only 3.3%. The

objective response rate used has been criticized by many, suggesting that

the response rate may be even lower than 3.3%.

Answer 9.13. The answer is C.

There are multiple active immunization approaches that have been

explored for cancer therapy, such as whole cell vaccines, dendritic cell

vaccines, and heat shock proteins. NK cell therapy has been explored as

a passive immunological therapy.

Answer 9.14. The answer is C.

Adoptive cell transfer therapies function by stimulating T cells ex vivo by

activating and expanding self/tumor-reactive T cells before transfer back

to the patient. CD8+T cells have been subject to much research because

they are potent effectors of the adaptive tumor response. CD4+T cells

are more controversial, because they can either help or hinder antitumor

immune responses.

Answer 9.15. The answer is A.

The graft-versus-leukemia effect from donor lymphocyte infusions is

thought to be due to the increase in recognition of target antigens on the

residual tumor cells. This will result in ultimate tumor cell kill. Lack of

presence of KIRs recognized by donor NK cells confers a better response

and more graft-versus-leukemia effect.

Answer 9.16. The answer is B.

Antibodies directed at the glycoprotein CEA have not been successful

in the treatment of solid tumors. This is mainly because of the lack of

penetration of the antibody into the tumor tissue in vivo.

Answer 9.17. The answer is C.

Immunoediting is a mechanism where the tumor develops mechanisms

that prevent the immune system from recognizing the tumor and respond-

ing appropriately. Immunosurveillance is the process of the immune sys-

tem observing for the development of malignancies. Immune escape is the

process of exerting selective pressure by the immune system that leads to

outgrowth of mutated tumor variants, ultimately leading to the loss of

recognition by the immune system.

Answer 9.18. The answer is C.

Clear cell histology predicts response to high-dose IL-2. Other predictors

of response to IL-2 therapy include late relapse (occurring>6 months

after nephrectomy), good performance status, and lack of bone metas-

tases.