10 Principles of Immunotherapy

Sarah B. Goldberg

QUESTIONS

Each of the numbered items below is followed by lettered answers. Select the ONE lettered answer that is BEST in each case unless instructed otherwise.

Question 10.1 Which of the following types of immunity is most responsible for the host response to tumor development?

A. Humoral immunity

B. B-cell–mediated immunity

C. T-cell–mediated immunity

D. Antibody-mediated immunity

Question 10.2 Currently, what is the proposed mechanism for using immunotherapy to destroy cancer cells?

A. Develop antibodies to target growth factors on cancer cells

B. Increase levels of immune lymphocytes

C. Develop antibodies to directly destroy the cancer cells

D. Increase levels of antigen-presenting cells

Question 10.3 A 55-year-old woman with metastatic melanoma enters a clinical trial with a cancer vaccine. Approximately 4 weeks after starting treatment she develops abdominal pain and watery diarrhea. Which of the following is the most likely diagnosis and the etiology?

A. Autoimmune colitis from activation of T cells against antigen found in cells lining the gastrointestinal tract

B. Autoimmune colitis from antibody production targeting antigen found in cells lining the gastrointestinal tract

C. Infectious colitis from immunosuppression due to aberrant T-cell production

D. Infectious colitis from contamination of the vaccine product with a virus capable of infecting the gastrointestinal tract

Question 10.4 Expression of the Epstein–Barr virus (EBV) latent gene EBNA is seen in which of the following cancers?

A. Nasopharyngeal carcinoma

B. Burkitt lymphoma

C. T-cell lymphoma

D. All of the above

Question 10.5 A 20-year-old sexually active woman inquires about the role of the human papilloma virus (HPV) vaccine in relation to cervical cancer. Which of the following statements regarding the HPV vaccine is CORRECT?

A. It prevents the development of cervical cancer in all patients

B. It induces regression of cervical cancer tumors

C. It prevents infection with HPV 16 and 18

D. It prevents the development of cervical cancer in patients infected with HPV 16 and 18

Question 10.6 Which of the following is an approach to cancer immunotherapy?

A. Passive transfer of activated immune cells with antitumor activity

B. Active immunization to enhance antitumor reactions

C. Nonspecific stimulation of immune reactions

D. All of the above

Question 10.7 Which of the following is an example of an immunotherapy that works by nonspecific stimulation of immune reactions, and in which disease has it shown to be effective?

A. Cancer vaccine in hepatocellular carcinoma

B. Adoptive immunotherapy in lung cancer

C. IL-2 in melanoma

D. Anti-CTLA4 in pancreatic cancer

Question 10.8 A 48-year-old man presents with hematuria, and CT imaging reveals a 5-cm kidney mass. Imaging of his chest shows multiple small bilateral lung nodules consistent with metastatic renal cell cancer. He is asymptomatic and in otherwise good health. You discuss treatment options with him including the use of IL-2 therapy. Which of the following statements is TRUE regarding the use of IL-2 in this situation?

A. IL-2 is very well-tolerated with minimal side effects in the majority of patients

B. IL-2 is FDA-approved for multiple cancer types given the excellent outcomes, including kidney cancer, melanoma, and lung cancer.

C. The chance of tumor regression with the use of IL-2 in kidney cancer is approximately 75%.

D. Although tumor response is seen in approximately 20% of patients with kidney cancer treated with IL-2, some patients can have durable benefit without tumor progression for several years.

Question 10.9 Which of the following results in inhibition of T cells?

A. CTLA-4

B. CD28

C. B7-1

D. B7-2

Question 10.10 Of over 1,000 vaccine treatments that have been studied, what is the approximate overall objective response rate to vaccines for cancer treatment?

A. <5%

B. 10%

C. 30%

D. 50%

Question 10.11 The purpose of checkpoint molecules such as CTLA-4 and PD-1 are to:

A. Enhance the immune response against infectious agents by activating T cells.

B. Enhance the immune response against cancer by activating T cells.

C. Protect normal tissues against autoimmunity by inhibiting T cells.

D. Protect normal tissues from tumorigenesis by stimulating the immune system.

Question 10.12 A 67-year-old man presents with abdominal pain and weight loss and is found to have multiple liver masses and diffuse lymphadenopathy. Biopsy of a liver lesion confirms metastatic melanoma. He is otherwise healthy with no other significant medical problems. Which of the following is accurate regarding the use of immunotherapeutic agents in metastatic melanoma?

A. Nivolumab is an inhibitor of the checkpoint molecule CTLA-4, and its use can result in significant tumor regression

B. Nivolumab often results in autoimmune toxicity while ipilimumab is rarely associated with side effects

C. Both nivolumab and ipilimumab can result in durable tumor regression

D. The combination of nivolumab and ipilimumab does not appear to result in additional toxicity than either agent alone

Question 10.13 Which of the following has been associated with death in trials of nivolumab for lung cancer?

A. Neutropenia

B. Pneumonitis

C. Hepatitis

D. Hypophysitis

Question 10.14 Which is TRUE regarding cancer vaccines?

A. Cancer vaccines have a high rate of efficacy but their use is limited due to toxicity

B. Cancer vaccines have a high rate of efficacy and are currently used in multiple tumor types to induce tumor regression.

C. Cancer vaccines have a low rate of efficacy because of their inability to generate antitumor T cells

D. Cancer vaccines have a low rate of efficacy despite their ability to generate antitumor T cells

Question 10.15 Which of the following is TRUE regarding sipuleucel-T?

A. Sipuleucel-T is a vaccine loaded with prostatic acid phosphatase linked to GM-CSF.

B. The response rate to sipuleucel-T is approximately 50%.

C. Sipuleucel-T significant prolongs time to disease progression and overall survival in men with prostate cancer.

D. All of the above.

Question 10.16 What is the purpose of adoptive cell transfer therapies?

A. Decreasing the number of reactive T cells ex vivo and transfer back to the patient

B. Increasing the number of cytokines ex vivo and transfer back to the patient

C. Activating and expanding tumor-reactive T cells and transfer back to the patient

D. Modulating CD4+ tumor-specific T cells before transferring back to the patient

Question 10.17 Which of the following is CORRECT regarding adoptive cell therapy?

A. Adoptive cell therapy is only effective if the lymphocytes are genetically modified prior to infusing them into the patient.

B. Both nonviral- and viral-based gene delivery platforms have been used to genetically modify cells for use in adoptive cell therapy

C. Targeting antigens that are expressed only on tumor cells and not on normal tissue can decrease the toxicity associated with on-target, off-tumor effects of the lymphocytes

D. B and C only

Question 10.18 Which of the following indicates the potential utility of anti-CD19 CAR T cells?

A. They have been used in many types of solid tumors because of the high prevalence of CD19 on solid tumor cells.

B. Because they are found on almost all malignant B cells, they have been tested in patients with hematologic malignancies.

C. Toxicity associated with this therapy is typically long term due to graft-versus-host disease.

D. B and C only

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