Biotherapy Oncologic Nursing

Biotherapy
What is Biotherapy?
• A treatment with agents derived from biological responses
and sources.
• A treatment of disease using substances obtained or derived
from living organisms.
Approaches of Biotherapy
• Active Immunotherapy
- giving tumor-bearing host agent that are designed to elicit an immune
response to retard or eliminate tumor growth.
• Specific
- immunization with tumor cell or tumor cell extracts as antigens or
vaccines.
• Non-specific
- to boost overall immunity through adjuvants.
Approaches of Biotherapy
• Passive Immunotherapy
- administration or transfer of previously sensitized immunologic reagents or
immune reactive cell to a tumor-bearing host.
• Adoptive Immunotherapy
- transfer of sensitized cells.
Major agents used in Biotherappy
1. Interferons (IFN)
2. Lymphokines-Interleukins (LI-2)
3. Hematopoeitic Growth Factor (HGF)
4. Monoclonal Antibodies (MoAb)
5. Radioimmunotherapy
6. Epidermal Growth Factor Receptor - Tyrosine Kinase Inhibitor (EGFR-TKI)
7. Angiogenesis Factor
Interferons ( IFN )
• Is a family of glycoproteins hormones possessing pleiotrophic biologic
effects.
• 3 major classes
1. Alpha (IFN-α)
2. Beta (IFN-β)
3. Gamma (IFN-γ)
• IFN-α and IFN-β are produced by leukocytes and fibroblast meanwhile
IFN-γ Is produced by T-Lymphocytes.
• IFN-γ is more potent in activating macrophages.
Interferons ( IFN )
• IFN have a wide range of biologic effects including
• Antiviral
• Antiproliferative
• Immunomodulatory
• Antiviral: Renders uninfected cells resistance to attack by the virus.
• Antiproliferative: Extends all phases of the cell cycle and lengthens
overall cell generation time.
• Immunomodulatory: Increases the potential of NK cells
Interferons ( IFN )
• Low doses of IFN stimulate antibody production and high doses have
suppressive effects.
• IFN has shown efficacy in tumors such as melanoma, renal cancer
cells, ovarian carcinoma and superficial bladder cancers.
• Route of Administration: IM, SubQ and IV but also given intralesion,
intraperitoneal, intravesical, intraarterial and intrathecal.
• Side effects: Flu-like symptoms, Fever (40°c), Headaches, Myalgias,
Arthralgias, Malaise, Fatigue, Anorexia with weight loss
Interferons ( IFN )
• IFN therapy have to be held or dose reduced if the side effects
became too severe or chronic.
• Administered before bedtime
• X Patients with strong history of CVD !!!
Interleukins (IL-2)
• Activates T-cells
• Supports the growth and maturation of subpopulations of T-cells
• Stimulates cytotoxic T-cells and proliferation and activity of NK cells
• LAK (Lymphosine Activated Killer) cells is the basis for adoptive
immunotherapy.
• IL-2 can reverse immunodeficiency
• Approved treatment of both renal cell cancer and melanoma
• High doses by IV bolus every 8 hours for up to 14 doses
Interleukins (IL-2)
• Side effects
• chills, fevers, headaches, myalgias, arthralgias and general malaise
are given pretreatment with acetaminophen and NSAIDs.
• major cardiovascular and pulmonary toxicity have treatments of
low-dose vasopressors (dopamine or neosynepherine)
• nausea, vomiting, diarrhea and anorexia is treated with multiple
anti-emetics and antidiarrheal agents.
• CNS toxicity may lead to coma and death if therapy is
discontinued.
Hematopoietic Growth Factor (HGF)
• a family of glycoproteins responsible for proliferation, differentiation
and maturation of hematopoietic cells in vitro.
• stimulates functions of certain mature leukocytes.
➢ Sargramostim (Leukine; GM-CSF) shortens time tom neutrophil

2
recovery following chemotherapy administration.

➢ 250 mcg/㎡/day
➢ side effects: bone pain, mild rash, transient-low grade fevers and injection site
reactions.
➢ Filgrastim (Neupogen; G-CSF) is focused on after chemotherapy use
as patients demontrated a shorter duration of neutropenia, fewer
days of antibiotic therapy and a reduce incidence and severity of
mucositis.
➢ 5 mcg/kg until absolute neutrophil count (ANC) recovery to normal or near
normal levels.
➢ given 1-3 days after completion of chemotherapy
➢ It's only drawback is the need of daily dosing because of the kidney's
rapid clearance
➢ Pegfilgrastim (Neulasta) increases Filgrastim's molecular size

which impairs renal clearance and prolongs circulation time
and duration of action.
➢ 6 mg per chemotherapy cycle SubQ 1 to 3 days after
chemotherapy.
➢ Side effects: bone aches and pains
➢Epoetin Alfa (Epogen, Procrit) is for treatment of anemia in cancer
patients.
➢ Darbepoetin Alfa (Aranesp) has a longer half-life which allow for less
frequent dosing.
➢ 150 to 200 mcg subQ every 2 weeks
➢ Side effects: fatigue, edema, nausea, vomiting diarrhea, fever and dyspnea
➢ Oprelvekin or IL-11 (Neumega) stimulates the growth and
development of megakaryocytes and platelets. It is used to prevent
severe chemotherapy induced thrombocytopenia and to reduce the
need for platelet transfusions.
Monoclonal Antibodies (MoAb)
• are produced when an antigen invades the body
• mediate an anti-tumor cytotoxic effect through complement-
dependent cytotoxicity or antibody-dependent cellular cytotoxicity
• used to directly against cell surface receptors involved in proliferation
to block or downgrade the number of available receptors.
➢ Rituxan (chimeric anti-CD20 MoAb rituximab)
• targets the CD20+ antigen found on the surface of normal pre-B and B cells
including the malignant B cells of over 95% of non-Hodgkin's lytmphomas.
• mediate antibody-dependent cytotoxicity by human NK cells and activate
complement-dependent cytolysis.
• used as a frontline therapy for newly diagnosed NHLs in combination with
CHOP chemotherapy. Response rate increased to 95% to 100%
➢ Trastuzumab (Herceptin)
• the first for use in solid tumors
• a recombinant DNA MoAb that selectively binds to the HER2 protein
• shifted trastuzumab-chemotherapy combinations are first line treatment of
patients with HER2/neu-positive MBC
➢Gemtuzumab Ozogamicin (Mylotarg)
• a MoAb targeted chemotherapy that binds specifically to the CD33+ antigen
found on the surface myeloid leukemia cells in more than 30% of patients
with AML.
• treatment dose is 9 mg/㎡ IV infusion run over 2 hours, every 14 days, for 2
cycles.
➢ Denileukin Difitox (Ontak)
• a fusion protein; the receptor-binding domain of IL-2 is fused to the diptheria
toxin to make a combination MoAb/vaccine
• targets activated T cells expressing CD25 and releases a toxin that inhibits
protein synthesis and cell death
• maximize tumor targeting while minimizing potential side effect to normal
cells
• used in the treatment of persistent or recurrent cutaneous T-cell lymphoma
and other NHLs whose malignant cells express the CD25 component.
• Dosages of 9 to18 mcg/kg/day IV for 5 days every 21 days is prescribed
➢ Alemtuzumab (Campath)
• directed against CD52 cell surface antigen
• indicated for treatment of B-cell chronic lymphocytic leukemia in patients
who have been treated with alkalyting agents and have failed fludarabine
therapy.
• 3 mg initial IV dose infused over 2 hours daily until tolerated without
reactions. Doses are escalated to 30mg IV 3 times/week for 12 weeks.
• antiinfection prophylaxis are given to patients because the therapy may leave
patients at risk for infection.
➢ Bevacizumab (Avastin)
• directly target vascular endothelial growth factor (VEGF) and a ligand that
attaches to VEGF receptor, stimulating angiogenesis.
• attaches to VEGF so that the receptors on endothelial cells are unable to
attach to VEGF thus cannot stimulate growth and survival and inhibits
angiogenesis-signaling cascade.
• used a first line therapy for patients with Metastatic Colorectal Cancer (MCRC)
with 5-FU-based chemotherapy
• 5 mg/kg IV every 2 weeks
• toxicities: bleeding, thrombosis, hypertension, diarrhea and proteinuria.
➢ Cetuximab (Erbitux)
• chimeric immunoglobulin GI MoAb that targets the extracellular domain of
EGFR with high specifity and affinity.
• it inhibits ligand binding and thereby inhibiting subsequent EGFR activation
• doses of 400 mg/㎡ IV over 2 hours as an initial dose, followed by 250 mg/㎡
IV over 1 hour weekly
• Side effect: Acneiform Rash
• patients are advised to limit sun exposure and practice good skin hygiene
Radioimmunotherapy
• combines radioactive isotopes such as Iodine-131 (I-131) and
Yttrium-90 (Y-90) with a MoAb. Radioisotopes is carried to the tumor
by the MoAb that attaches to a specific antigen present on the tumor
cell surface.
• radiation is targeted to tumor with the surrounding normal cells
receiving less radiation than if they were exposed to external beam
radiation therapy.
• cancer cells are destroyed by the combination of targeted radiation
therapy, biologic effects of MoAb and the crossfire effect of the
radiation.
Radioimmunotherapy
➢ Y-90 Ibritumomab Tiuxetan (Zevalin)
• treatment for patients with relapsed or refractory low-grade follicular or
transformed B-cell NHL
• single treatment course on 2 days, 1 week apart, dosage is based upon the
patient's platelet count.
• Y-90 only emits beta radiation and doesn't penetrate outside the patients
body
• patients are taught to wash hands throughly and dispose any material
contaminated with body fluids for the first 3 days. use condoms for a week
after treatment and avoid pregnancy for 1 year after treatment.
Radioimmunotherapy
➢ Tositumomab I-131 (Bexxar)
• emits beta and gamma rays

• treatment for B-cell lymphoma in combination with radiation therapy.
• Side effects: hematologic toxicity, fatigue, fever, nausea, vomiting, rash,
pruritis and infection.
Epidermal Growth Factor Receptor -
Tyrosine Kinase Inhibitor (EGFR-TKI)
• EGFR is a growth promoting protein found on the surface of many
different types of tumor cells including lung, breast, and colon
cancers.
• EGFR-TKI is responsible for multiple downstream signaling pathways
governing tumor growth.
• important treatment for patients whose disease has progressed while
receiving chemotherapy and for who cannot tolerate the toxicities
Epidermal Growth Factor Receptor -
Tyrosine Kinase Inhibitor (EGFR-TKI)
➢ Getfinib (Iressa) and Erlotinib (Tarceva)
• treatments of patients with advanced Non-Small Cell Lung Cancer (NSCLC)

• selectively inhibits the EGFR-TK activity
• oral and taken once daily
• non-smokers and women are more likely to respond to this treatment
• Side effects: skin toxicities, diarrhea, opthalmologic toxicity
Angiogenesis Inhibitors
• Angiogenesis is the process of blood vessel formation. Uncontrolled
angiogenesis is pathologic and may lead to the development and
progression of malignant tumor.
• a class of drugs that inhibits fromation of blood vessels, thus cutting
off the supply of nutrients and oxygen to malignant tumors, resulting
to their death.
Angiogenesis Inhibitors
➢ Thalidomide (Thalomid)
• inhibits basic fibroblast growth factor (bFGF) and VEGF production reversing
the angiogenic switch.
• a cytotoxic agent that inhibits processing of mRNA that encodes peptide
molecules, TNF-α and angiogenic VEGF
• Steps for Thalidomide Education and Precaution Safety (STEPS) was
developed to control and monitor access to the drug due to it's teratogenicity.
• taken orally at doses of 200mg/day and escalated if tolerable.
• Side effects: sedation, lightheadedness, peripheral neuropathy, constipation
and skin rash. Deep Venous Thrombosis (DVT) is a serious complication so
patients are placed prophylactically on anticoagulation either with warfarin or
low-molecular-weight heparin
• taken at bedtime and a good bowel regimen
Considerations
✓ Biotherapeutic agents are well tolerated by geriatric patients
✓ Many of the newest targeted therapies are oral and have a very few
side effects
✓ For elderly patient receiving IFN or self-injection biotherapy, assess
their willingness to learn as well physical capabilities that may inhibit
their ability to learn
✓ Hepatic and renal functions should be assessed before and during
the treatment
✓ Elderly patients are more at risk for cardiac complications
✓ Evaluate patient's medication profile to detect drugs that maybe
contraindicated and may cause additional toxicity
THANK YOU! ☺

Biotherapy Oncologic Nursing

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Biotherapy Oncologic Nursing

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Biotherapy

➢ Sargramostim (Leukine; GM-CSF) shortens time tom neutrophil

recovery following chemotherapy administration.

➢ Pegfilgrastim (Neulasta) increases Filgrastim's molecular size

• emits beta and gamma rays

• treatments of patients with advanced Non-Small Cell Lung Cancer (NSCLC)

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