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Transcript
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?