Transcript Project Overview

Principles of
Biotherapy
Objectives
 At
the end of this session the
participant will be able to:
◦ Identify biotherapeutic agents
◦ Describe indications and actions of
commonly used medications
◦ Identify side effects and nursing
interventions for specific biotherapy agents
2
Biotherapy
 Definition
◦ The term biotherapy includes agents
derived from biological sources and/or use
of agents that affect biological responses
 History
◦ William B. Coley, MD, formed the basis for
the use of cytokines
◦ Hybridoma Technology
 The production of large quantities of very pure
antibodies (monoclonal antibodies)
3
Biotherapy Mechanism
of Action

Biotherapy can be classified into three
major divisions by mechanism of
action:
◦
◦
◦
Agents that augment, modulate or restore
the host’s immune responses
Agents that have direct anti-tumor activity
Agents that have other biological effects (e.g.,
differentiating agents, agents that affect the
tumor’s ability to metastasize, or agents
affecting cell transformation)
4
Types of Biotherapy
 Interferons
Antiviral, antiproliferative
immunomodulator
 Interleukin-2
Stimulates growth and
maturation of T-cell subsets
Stimulates cytotoxic
T-cells
Stimulates production of other
lymphokines/ cytokines
5
Types of Biotherapy
 Retinoids
all-trans
retinoic acid
 Hematopoietic
Growth
Factors
Facilitate differentiation and
suppress proliferation of
cancer cells
Colony stimulating factors
that and regulate different
levels of the hematopoietic
cascade
G-CSF
GM-CSF
erythropoetin
thrombopoetin
6
Basic Definitions
 Antibody- secreted immunoglobulin
proteins that bind specifically to an
antigen/target
 Antigen- a foreign substance recognized
by the immune system. A substance that
reacts with antibodies or T Cell Receptors
 B Lymphocytes- produce distinct
antibody molecules
7
Background





At the turn of the 19th
Century…”Magic Bullets could
effectively target compounds
and eradicate sites of disease”,
Paul Ehrlich
1950s idea was explored
1990s first products developed
Turn of the 21st century
development and engineering of
monoclonal antibodies full
speed ahead…
Normal cells that do not
express the target for MoAbs to
bind to are spared side effects
8
MoAbs Functions

Are artificially produced in the
laboratory and are designed to bind
to the antigens/targets expressed on
the surface of malignant cells

Enhance the patient’s immune
response

Supplement the effects of
chemotherapy in eradicating disease
9
Types of Monoclonal
Antibodies
Human
Murine
Chimeric
Humanized
-umab
-momab
-ximab
-zumab
10
Key Reminders
For MoAb Therapy




There is a high incidence of infusion related
toxicities including severe rigors, fever, chills,
hypotension, N/V and hypersensitivity reactions
Nursing must be aware of potential side effects
and have established a management plan for
anticipated side effects
Infusion reactions most often occur during initial
infusions but are still possible with subsequent
infusions
Administering premedications and slowing
infusion rates may minimize side effects
11
Key Reminders
For MoAb Therapy



Some MoAbs may cause profound
immunosuppression and require patients to be
on anti-infective prophylaxis (Campath®)
Reactivation of CMV, Hepatitis B, HSV,VZV may
occur and require patient to receive antiviral
treatment
Patient Family Education should include
information about MoAb therapy and how side
effects differ from chemotherapy
12
Types of Biotherapy Used
For Non-Cancer Diseases
Rituximab (Rituxan®)
 Infliximab (Remicade®)
 Adalimumab (Humira®)
 Daclizumab (Zenapax)
 Etanercept (Enbrel®)
 Abatacept (Orencia®)
 Natalizumab(Tysabri®)

13
Types of Immunologic Drugs
Used For Non-Cancer
Diseases
 IVIG
 Win
Rho
 Atgam
14
QUESTIONS?