II. History

  1. Initially targeted to CD20 on immune cells to treat Lymphoma and Leukemia
  2. Lead to immunosuppressive use in Autoimmune Conditions such as Rheumatoid Arthritis

III. Mechanism

  1. Targeted to solid tumors (e.g. Breast Cancer, Lung Cancer and Colon Cancer)
  2. Bind extracellular Ligands and receptor binding sites

IV. Pharmacokinetics

  1. Large molecules (150,000 Da)
  2. Water-soluble
  3. Proteins are denatured by intestinal acids (therefore must be used intravenously)
  4. No hepatic metabolism (therefore no significant Drug Interactions)
  5. Long half-lives of days to weeks

V. Adverse Effects: Immune Checkpoint Inhibitors

  1. Precautions
    1. Toxicity may be severe or even life threatening
    2. Reactions may be delayed for even a year after medication is discontinued
  2. Hypersensitivity
    1. Older monoclonal antibodies were produced in mice and resulted in hypersensitivity
    2. Newer drugs use a greater percentage of human antibodies (65-100%)
    3. Corticosteroids tapered over a 4-6 week course may be needed
  3. Diarrhea or colitis
    1. Exclude Clostridium difficile
    2. Treat symptomatically
  4. Autoimmune endocrine disorders
    1. Thyroid disease
    2. Type I Diabetes Mellitus
  5. Other inflammatory conditions
    1. Rashes
    2. Pneumonitis
    3. Hepatitis
  6. References
    1. (2018) Presc Lett 25(10): 57

VI. Adverse Effects: EGFR Inhibitors

  1. Adverse effects related to EGFR targeted on cancer cells, but also present in skin and GI tract
  2. Dermatitis often is an indicator that the EGFR inhibitor is working
  3. Diarrhea occurs in 50% of patients on EGFR inhibitors

VII. Adverse Effects: VEGF inhibitors which inhibit Angiogenesis (e.g. Avastin)

  1. Adverse effects are vascular related
  2. Bleeding
  3. Thrombosis
  4. Hypertension

VIII. Disadvantages

  1. Very expensive (typically upwards of $10,000 per course)

IX. Preparations: General Monoclonal Antibodies

  1. Target: Cell Surface Markers (CD20)
    1. Ibritumomab tiuxetan (Zevalin): Used Non-Hodgkin's Lymphoma
    2. Rituximab (Rituxan): Used in Non-Hodgkin's Lymphoma and Rheumatoid Arthritis
    3. Tositumomab (Bexxar): Used in Non-Hodgkin's Lymphoma
  2. Target: Cell Surface Markers (CD52)
    1. Alemtuzumab (Campath): Used in CLL
  3. Target: Cell Surface Markers (CD33)
    1. Gemtuzumab ozogamacin (Mylotarg): Used in AML
  4. Target: Epidermal Growth Factor Receptor (EGFR, HER1)
    1. Cetuximab (Erbitux): Used in Colon Cancer and head and neck tumors
    2. Panitumumab (Vectibix): Used in Colon Cancer
  5. Target: Vascular Endothelial Growth Factor (VEGF)
    1. Bevacizumab (Avastin): Used in Colon Cancer and Non-Small Cell Lung Cancer
  6. Target: HER2-neu
    1. Trastuzumab (Herceptin): Used in Breast Cancer (where HER2-neu is overexpressed)

X. Preparations: Immune Checkpoint Inhibitors

  1. Target: Cytotoxic T Lymphocyte associated-4 (CTLA-4)
    1. Ipilimumab (Yervoy)
  2. Target: Programmed Cell Death Protein 1 (PD-1)
    1. Pembrolizumab (Keytruda)
    2. Nivolumab (Opdivo)
  3. Target: Programmed death Ligand-1 (PDL-1)
    1. Atezolizumab (Tecentriq)
    2. Avelumab (Bavencio)
    3. Durvalumab (Imfinzi)
  4. References
    1. Dine (2017) Asia Pac J Oncol Nurs 4(2): 127–135 [PubMed]
    2. American Cancer Society
      1. https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/immunotherapy/immune-checkpoint-inhibitors.html

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Ontology: Monoclonal antibody immunoconjugate therapy (C0854646)

Concepts Therapeutic or Preventive Procedure (T061)
Italian Terapia con anticorpo monoclonale immuno-coniugato
Japanese 免疫抱合モノクローナル抗体療法, メンエキホウゴウモノクローナルコウタイリョウホウ
English Monoclonal antibody immunoconjugate therapy
Czech Léčba imunokonjugovanou monoklonální protilátkou
Hungarian Monoklonális antitest immunkonjugációs kezelés
French Traitement par anticorps monoclonaux conjugués
Portuguese Terapia imunoconjugada com anticorpo monoclonal
Spanish Tratamiento con anticuerpos monoclonales inmunoconjugados
Dutch monoclonale antistof immuno-geconjugeerde therapie
German Therapie mit immunkonjugierten monoklonalen Antikoerpern