Monoclonal Antibodies

The cell surface contains antigens, which are referred to as CD, which stands for "cluster of differentiation." The antibodies are produced against a specific antigen. When administered, usually by an IV injection, the antibody binds to the antigen, which may trigger the immune system to result in cell death through complement-mediated cellular toxicity, or the antigen-antibody cell complex may be internalized to the cancer cell, which results in cell death. Monoclonal antibodies also may carry radioactivity, sometimes referred to as hot antibodies, and may be referred to as ra-dioimmunotherapy, so the radioactivity is delivered to the cancer cell. Antibodies that contain no radioactivity are referred to as cold antibodies.

All monoclonal antibodies end in the suffix -mab. The syllable before -mab indicates the source of the monoclonal antibody (see Table 88-7). When administering an antibody for the first time, one should consider the source. The less humanized an antibody, the greater is the chance for the patient to have an allergic-type reaction to the antibody. The more humanized the antibody, the lower is the risk of a reaction. The severity of the reactions may range from fever and chills to life-threatening allergic reactions (which have resulted in death). Premedication with acetaminophen and di-phenhydramine is common before the first dose of any antibody. If a severe reaction occurs, the infusion should be stopped and the patient treated with antihistamines, corticosteroids, or other supportive measures.

Alemtuzumab

Alemtuzumab is the antibody to the CD52 receptor present on B and T lymphocytes. The pharmacokinetics of alemtuzumab demonstrate a terminal half-life of 7 days. Alemtuzumab has shown clinical activity in the treatment of chronic lymphocytic leukemia. Severe and prolonged (6 months) immunosuppression may result, which necessitates prophylaxis with cotrimoxazole and antivirals to prevent opportunistic infections.

Table 88-7 Syllable Source Indicators for Monoclonal Antibodies

u

Human

0

.Mouse

A

Rat

E

Hamster

1

Primate

XI

A cross between humanized and animal source

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