3.3-3.4

Interleukins

- (immune system modulator - upregulate immune system) - Type of cytokine that stimulates the immune system to fight the cancer (signaling molecule). - Bind to receptors and are involved in the communication between leukocytes. - Immunotherapy for melanoma and renal carcinoma have successfully used interleukin-2 and it: blocks the reproduction and spread of cancer cells, stimulates the development of white blood cells that attack cancer (natural killer cells), and causes cancer cells to release chemicals that attract cancer-killing immune system cells.

Interferons

- A type of cytokine(family of proteins) that is crucial in controlling the growth and activity of immune system cells when released (signaling molecule). -These proteins do not directly kill cancerous cells, but instead they boost the immune system response or increase the lysis potential of natural killer T cells. -Interferons increase the resistance of normal cells to natural killer (NK) cells and make cancer cells more vulnerable to killing by cytotoxic T cells. -Note: Interferons is also used to combat viral infection because of their ability to interfere with viral replication - that doesn't apply in cancer treatment, just another use of therapeutic usage.

What is the purpose of clinical trials?

- Assess the safety and determine the efficacy or effectiveness of drug or treatment.

When does the FDA begin its oversight?

- Companies can submit results of Phase I-III Trials for drugs or treatment to FDA. -If drug or treatment gains approval, then FDA begins oversight or gathering info on safety and effectiveness once a drug or treatment goes to market or can be used on any patient.

What is a dendrimer?

- Device with branching shape. Combine treatment, detection, diagnosis, and monitoring all in one device. Device would have therapeutic agent to deliver if cancer is detected.

How do we use animal studies in our research?

- Generally animal studies are done before approval is granted to begin Phase I of Clinical Trials. -This will give us an idea in a related species if there are safety issues and if drug or treatment is effective.

What is a nanotube?

- Like the nanopore, this device will help locate mutations associated with cancer. -Tubes are carbon rods about ½ diameter of DNA molecule that not only can detect altered genes but can help researchers pinpoint exact location of changes. - To pinpoint location, we use bulky molecules attached to regions associated with cancer.

What are some of the human abuse cases that led to increased regulation and legislation?

- Nazi Experiments, Tuskegee Syphilis Study, Dr. Beecher's Article on Studies, Willowbrook Hepatitis Study are examples.

What is function of the IRB in relation to clinical trials? What is their responsibility?

- The Institutional Review Board (IRB) is responsible for reviewing drug or treatment applications to begin clinical trials. - The IRB considers each application and decides whether a drug or treatment is scientifically worthy based on animal studies and reviews the potential design of the clinical trial to make sure that ethical guidelines for participants are met. - The IRB will also oversee Phase I-Phase III prior to FDA approval to market the drug.

What is a quantum dot?

- Tiny crystals that glow when they are stimulated by UV light. - The wavelength or color depends on size of crystal. Latex beads filled with these crystals can be designed to bind to specific DNA sequences. -By combining different size crystals in a bead, scientists create unique spectral bar codes to identify a particular region of DNA. Could eliminate the need for biopsy.

What is a cantilever?

- Tiny levers which are anchored at one end and engineered to bind molecules associated with the development of cancer - changes to DNA or proteins. When molecules bind, lever will bend and can be detected.

What is a nanopore?

- Tiny pores in devices allowing single stranded DNA to pass through. - Scientists can monitor shape and electrical properties of each base in DNA so that they can detect errors or mutations in DNA associated with cancer.

Factorial Trial?

- Used to test medicines/treatments in combination. Group 1 gets drug A only. -Group 2 gets drug B only. -Third group gets both drug A and B. -Fourth group gets no treatment. More difficult to interpret results.

biofeedback therapy,

- a type of therapy designed to help patients become attuned to the way in which the body reacts to stress and learn ways to use the mind to influence many of the body's involuntary functions -. In a biofeedback therapy session, a patient is hooked to various sensors and is asked to view changes in heart rate, blood pressure, muscle response, or other physiological indicators on a computer screen as he or she experiences stress. -Patients learn how their bodies respond to this stress and monitor the way in which relaxation techniques change physiological output as measured on the screen. - The eventual goal of this therapy is that patients will be able to positively affect their physical response to stress, even when not looking at their feedback data. Biofeedback therapy has helped people with panic attacks and anxiety, digestive disorders such as Crohn's disease and irritable bowel syndrome (IBS), chronic headaches and asthma.

-Cancer treatment vaccines

- alert immune system to presence of cancer cells. - not to be confused with cancer prevention vaccines against HPV or Hepatitis B. -Cancer cells contain substances, called tumor-associated antigens, that are not present in normal cells or, if present, are at lower levels. -Treatment vaccines can help the immune system learn to recognize and react to these antigens and destroy cancer cells that contain them.

Immune checkpoint inhibitors

- drugs that block immune checkpoints. - These checkpoints are a normal part of the immune system and keep immune responses from being too strong and destroying normal cells. - By blocking them, these drugs allow immune cells to respond more strongly to cancer. -Normally when T cells with their surface proteins bind to proteins on surface of cancer cells, this initiate an immune system checkpoint which is like a circuit breaker in an electrical system tripping and turning off electricity. - This binding turns off a potential attack by immune system. These cells, being detected as normal cells and immune system ignores them. -Immune checkpoint inhibitors can tie up or bind to either T cells or cancer cells to keep this initiation of checkpoint from happening and keep the T cells turned on so they can kill cancer cells.

Immunotherapy

- is a type of cancer treatment that takes advantage of the body's own immune system to fight cancer cells. - Normally, the immune system is very good at hunting down and destroying harmful invaders, such as bacteria and viruses. - However, the immune system doesn't always recognize cancer cells as something foreign. - One approach to immunotherapy focuses on teaching the immune system to recognize and destroy cancer cells more accurately. -Another approach attempts to supplement a patient's immune system with cell proteins that boost its power to destroy cancer cells.

Radiation therapy

- is a type of cancer treatment that uses high doses of radiation to kill cancer cells. - The radiation works by making small breaks in the DNA inside of the exposed cells. -These breaks keep cancer cells from growing and dividing. -Treatment can take days or weeks to start causing cancer cells to die, and cells continue to die long after treatment is over. -Radiation therapy is typically a local treatment, affecting only the part of the body being treated. -Radiation therapy is also used to ease cancer symptoms caused by tumors. -Radiation therapy is often used in combination with other treatments, such as surgery and chemo, to ensure that all of the cancerous cells are removed.

Hormone therapy

- is a type of cancer treatment used to stop or slow the growth of cancer cells that use hormones to grow, such as prostate and breast cancers. -There are two types of hormone therapy for cancer treatment, those that block the body's ability to produce the hormones associated with the cancer and those that interfere with how these hormones behave in the body. -Hormone therapy is used to slow the growth of cancer, lessen the chance that cancer will return, or reduce or prevent symptoms in patients with prostate cancer who are unable to have surgery or radiation therapy.

Precision medicine

- is an approach to disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle of each person. -When applied to cancer treatment, precision medicine allows doctors to select treatments that are most likely to help patients, based on a genetic understanding of the patient and their cancer. -As researchers learn more about different types of cancer, treatments will be able to be tailored to the mutations in each type of cancer cell that lead to the development of cancer. -Patients will receive drugs that their tumors are most likely to respond to, and that their bodies are able to metabolize effectively.

Surgery

- is the removal of the tumor and surrounding tissue during an operation. -Surgery is the oldest type of cancer therapy and can be an effective treatment for many types of cancer. -mSurgery is often used as a treatment to remove all or some of the cancerous tissue after diagnosis or to ease cancer symptoms caused by tumors creating pain or pressure. -It can also be used for biopsy—to diagnose cancer and find out where the cancer is located, whether it has spread, and whether it is affecting the functions of other organs in the body.

Chemotherapy

- often referred to as "chemo," is a type of cancer treatment that uses drugs to kill cancer cells. -Chemo relies on powerful chemicals that target and kill fast-growing cells in your body. - Since cancer cells grow and multiply much more quickly than most cells in the body, chemo drugs are effective at destroying them. - However, the drugs are unable to differentiate between healthy and cancer cells, so other fast-growing and dividing cells, such as those that line your mouth and intestines and the cells that cause your hair to grow, are also killed. -Damage to healthy cells may cause other negative side effects. - Depending on the type and stage of the cancer, chemotherapy can destroy all cancer cells in the body, prevent cancer from spreading, and/or ease cancer symptoms caused by tumors creating pain or pressure.

Stem cell transplants are procedures that

- restore the blood-forming stem cells in people who have had theirs destroyed by cancer treatments, such as very high doses of chemo and radiation therapy -. In a stem cell transplant, patients receive healthy blood-forming stem cells that travel to the bone marrow and produce new blood cells. -The stem cells either come from the patient's own stem cells that were removed prior to treatment, or from a matching donor. - In patients with multiple myeloma or some types of leukemia, donor stem cells from a transplant can actually help fight cancer by attacking any cancer cells that remain in the body after the high-dose treatments.

Surgery works best for

- solid tumors that are contained in one area. -It is a local treatment, meaning that it treats only the part of the body that contains cancer. - Therefore, it cannot be used on a type of cancer that is not solid, such as a blood cancer like leukemia, or for a cancer that has spread. -Surgery is often used in combination with other treatments to ensure that all of the cancerous cells are removed.

Monoclonal antibodies

-- Scientists develop these antibodies in the lab to specifically match certain antigens on cancer cells so that immune system can selectively destroy them. -One strategy is listed below. Monoclonal antibody binds to cancer cell and T cell bringing them in close proximity T cell can destroy cancer cell.

When would radiation therapy be chosen over chemotherapy?

-.Can zero in on cancer cells in a tumor or at a particular site instead of all rapidly dividing cells by focusing external beam on tumors or by using brachytherapy (small implant delivering targeted radiation). -Used if cancer cells metastasized to lymph nodes or if surgery is not possible due to location of tumor. -Disadvantage - can cause DNA damage.

What is a haplotype?

-A combination of SNPs in a gene or on the same chromosome that tend to be inherited together.

What is the difference between the ways an occupational therapist works with a patient versus how a physical therapist works with a patient? How is their focus different?

-Both occupational therapists and physical therapist work with patients after accident, injury, or surgery. - Both will design exercises or activities for patients to become stronger as they work their way back from accident or surgery. -Occupational therapists are focused on getting patients back to doing activities necessary for daily living - showering, dressing, walking, climbing stairs, eating, etc. - Physical therapists are more focused on range of motion and strength and trying to get the patient back to pre-surgery/accident strength and motion. -Both occupational and physical therapists would work with someone who has had an amputation.

What types of nanodevices will most likely be ready in 15-25?

-Devices that integrate detection and therapy are 15-25 years away.

What is a myoelectric arm? How is it controlled and where does power to run it come from?

-Electrodes attached to patient that pick-up EMG signals that are amplified at a control unit and direct a battery powered motor to operate the limb. -The people that missed this question thought electrodes or connections to myoelectric device went directly to the brain. -We are not there yet.

Generally how do immunotherapies work? Then specifically, how do the following immunotherapy treatments work? What are the risks/benefits?

-In general, even though the immune system can prevent or slow cancer growth, cancer cells have ways to avoid destruction by the immune system. - For example, cancer cells may: Have genetic changes that make them less visible to the immune system .Have proteins on their surface that turn off immune cells. Change the normal cells around the tumor so they interfere with how the immune system responds to the cancer cells. -Immunotherapy helps the immune system to better act against cancer

What is limb salvage surgery? -What are the requirements for it to be successful?

-Mike was not a candidate for limb salvage surgery. -Chemotherapy was not successful. - In order to be a candidate, chemotherapy has to be successful and after the tumor is removed with healthy margins, the tendons, nerves, and blood vessels are intact (cancer/tumor cells did not spread to these tissues).

If a patient is not a candidate for limb salvage surgery (like Mike), how does surgeon prepare the limb in an amputation to receive a prosthetic device?

-Mike's surgeon, during the amputation surgery, had to construct a cuff or sleeve of muscle and bone that would be sufficient to allow a prosthetic to be securely attached.

What is nanoshell?

-Nano size beads coated with gold linked to antibodies that seek out cancer cells and when exposed to near infrared light could selectively kill cancer cells.

What is nanotechnology (range of sizes, purpose)? What is the advantage over traditional chemotherapy/radiation therapy?

-Nanotechnology consists of devices that are a billionth of a meter. -They are small enough to enter a cell or organelles to detect, diagnose, treat, or monitor disease. - The advantage over chemotherapy and radiation therapy is that we can more precisely treat cancer without harming normal cells and these devices would be more sensitive at detecting than our current diagnostic tests.

Which types of nanodevices will most likely be ready in the next 5-15 years?

-Quantum dots, nanopores, and other devices for detection and diagnosis could be available in 5-15 years.

Open Trial?

-Researcher and subjects know what treatment is being given. -Used in situations where it would be hard to conceal the therapy such as surgical technique - open versus laparoscopic. -You are going to know which one you got by length of the incision More prone to bias.

What is a SNP?

-Single nucleotide polymorphisms are the most common type of genetic variation among people. -Each SNP represents a difference in a single nucleotide. - If more than 1% of a population has the same SNP or substitution in the DNA sequence, then this variation can be classified as a SNP. -If a SNP occurs within a gene, then the gene is described as having more than one allele. -In these cases, SNPs may lead to variations in the amino acid sequence and production of a different protein or no protein. - Exception to this end results are SNPs that result in silent mutations - another nucleotide is substituted, but due to redundancy (codon wheel), still codes for the same protein.

Orphan drug trial?

-Status given to a rare disease that will be hard to recruit enough volunteers in a geographic area to participate in a clinical trial. -Basically, we are waiving requirements for regular process and allowing those interested in receiving drug or treatment to get it without going through the full-blown clinical trial process because we currently have no treatment. -We will still be documenting effects of drug or treatment and there will still be oversight, but this is fast track approach.

What is a double-blind study?

-This is a study in which neither the subjects or those researchers involved in the study know which subjects are getting which treatment (placebo or one of experimental ones). -This reduces bias from subjects and researchers when reporting effects. -Term placebo effect described in subjects when they think they are getting the experimental treatment and they report seeing improvement - wishful thinking.

What is a Crossover Trial?

-Used to test 2 treatments or drugs, but not at same time. Example 2 groups. - Group 1 gets drug A first, then drug B later. Group 2 gets drug B first, then drug A later.

How can we use patient's haplotypes and reactions to medications to predict future patient's reactions?

-We can take a look at historical data of how patients have responded to medications and their genetic profile (haplotype or SNP pattern on genes that impact using medication). -This allow us to then test patients who have not been treated so we can use their haplotype to predict response to treatment.

When would chemotherapy be the best choice? - What is the risk or downside of chemotherapy? Be specific.-

-Worried about effects of radiation therapy on reproductive cells/cancer risk in future .-Disadvantage that it affects all rapidly dividing cells in body (digestive lining, hair cells) -Can be used to kill cancer cells or in conjunction with other treatments to shrink tumors .-Can be used if cancer is in multiple locations.

Targeted therapy

-is a type of cancer treatment that is used to prevent cancer from growing and spreading. -It is technically a type of chemotherapy, but is different than standard chemotherapy that is nonspecific. -Targeted therapy drugs are developed specifically to target certain parts of the cell and the signals that are needed for a cancer to develop and keep growing. -For example, some targeted therapies block the enzymes that signal cancer cells to grow, whereas others induce apoptosis, or cell death, in cancer cells. -Targeted therapy is chosen for patients with specific cancers whose tumors have the specific gene mutation that codes for the target. -Patients who do not have the mutation would not be candidates; because the drug wouldn't have anything to target, the therapy would have no effect.

Oncolytic virus therapy

-this group of viruses include viruses found in nature as well as viruses modified in the laboratory to reproduce efficiently in cancer cells without harming healthy cells - To date, only one oncolytic virus—a genetically modified form of a herpesvirus for treating melanoma - has been approved. -Uses a virus that infects and breaks down cancer cells but does not harm normal cells. -Normal cells can kill the virus while cancer cells cannot. -The oncolytic virus is injected directly into a tumor. As the virus makes more and more copies of itself, it causes cancer cells to burst and die. -The dying cells release new viruses and other substances that can cause an immune response against cancer cells throughout the body.

What is precision medicine and how is it used to treat cancer?•

?•Use of info about lifestyle, environment, and genetics in order to tailor treatment for maximum effectiveness. -Examples -tumor cells in melanoma, some leukemias, and breast, lung, colon, and rectal cancers are tested for certain genetic changes when they are diagnosed (DNA sequencing) to see if we can use targeted therapy. Patient may also be tested for SNPs that may make them more responsive to one treatment than another Expensive Targeted Therapy is the foundation of precision medicine Used to prevent, diagnose, and treat disease

In what situation would surgery be the sole treatment?

Cancer in the original tumor site and has not spread or type of cancer that doesn't tend to metastasize like Basal cell Carcinoma or Squamous Cell Carcinoma. Can be done with scalpel, laser, cryosurgery.

What are the six steps in the engineering design process and what happens in each step?

Define Problem Investigate/Research/Generate Ideas Develop Solution Build Prototype and Test Evaluate Solution Present Solution

What is hormone therapy?

Drugs either block body's ability to produce hormones or interfere with action Most often used in with some types of breast cancer and prostate cancer Used in conjunction with other treatments Type of targeted therapy

What factors determine which cancer treatment(s) is/are selected?

•Type of cancer - cells/tissues of origin? •Mutation pattern of tumor cells? •Is it localized or has it metastasized (stage of cancer)?•Age of patient? •Availability of medical care/facilities •Insurance (ability to pay)?

How is stem cell transplant used in cancer treatment?•

•Used to restore blood-forming cells (bone marrow transplant) after treatment to wipe out cancerous bone marrow cells (chemo or radiation). •Can use healthy cells retrieved before treatment or a donor's cells •Commonly used to treat leukemia, multiple myeloma, neuroblastoma, lymphoma

What is target therapy and how does a patient know if their cancer can be treated using this approach?•

•tumor cells in melanoma, some leukemias, and breast, lung, colon, and rectal cancers are tested for certain genetic changes when they are diagnosed (DNA sequencing) to see if we can use targeted therapy. •Most targeted therapies are small-molecule drugs or monoclonal antibodies.- small molecule drugs block the process that helps cancer cells multiply and spread (example angiogenesis inhibitors) - monoclonal antibodies are combined with toxins, chemotherapy•example of targeted treatment - some tumor growth is fueled by hormones - these are called hormone responsive tumors. -This is a form of •Immunotherapy is an example of targeted treatment -helps your immune system fight cancer by allowing it to recognize and better target just cancer cells. •Targeted therapy is the foundation for precision medicine