Antibodies

Oxford American handbook of oncology. Second Edition. Oxford University Press (2015)


Monoclonal antibody therapies are engineered proteins that bind specifically to soluble factors in the blood or to cell surface molecules. These antibodies may block normal function of target molecules and lead to clearance of targets by immune mechanisms.

Since antibody therapies are developed using humanized or chimeric versions of mouse antibodies, they carry a risk of infusion reactions including hives, hypotension, or, rarely, anaphylaxis. Clinically useful monoclonal antibodies include the following.

Alemtuzumab (Campath-1H)

  • Mechanism: binds to CD52, a cell surface marker found on B and T cells
  • Route: intravenous
  • Uses: chronic lymphocytic leukemia, preparative regimens prior to transplantation
  • Notes: can cause myelosuppression and increased risk of infections such as CMV

Bevacizumab (Avastin)

  • Mechanism: binds to circulating VEGF, blocking its ability to bind to cells and thus inhibiting tumor neovascularization
  • Route: intravenous
  • Uses: metastatic colon cancer, metastatic non-small–cell lung cancer, renal cell carcinoma. Emerging uses include metastatic breast cancer, ovarian cancer, and pancreatic cancer.
  • Notes: can cause hypertension and proteinuria, can impair wound healing, and low risk of thrombosis

Cetuximab (Erbitux)

  • Mechanism: chimeric antibody that binds to the EGFR, blocking its kinase activity
  • Route: intravenous
  • Uses: metastatic colon cancer, squamous-cell head and neck cancer
  • Notes: risk of severe or fatal infusion reactions. It may cause acneiform rash and hypomagnesemia.

Panitumumab (Vectibix)

  • Mechanism: humanized antibody that binds to EGFR, blocking its kinase activity
  • Uses: metastatic colon cancer
  • Notes: low risk of infusion reaction. It may cause acneiform rash and hypomagnesemia.

Rituximab (Rituxan)

  • Mechanism: binds to CD20, a cell surface marker found on B cells
  • Route: intravenous
  • Uses: B -cell malignancies, often in combination with cytotoxic chemotherapy
  • Notes: low risk of infusion reaction

Trastuzumab (Herceptin)

  • Mechanism: binds to Her-2, a cell surface molecule on Her-2-positive breast cancer
  • Route: intravenous
  • Uses: Her-2-positive breast cancer, both in the adjuvant and metastatic settings
  • Notes: risk of decreased ejection fraction and congestive heart failure, particularly when combined with cardiotoxic chemotherapy
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