How Do Antineoplastic Monoclonal Antibodies Work?

Antineoplastic monoclonal antibodies are a class of drugs used to treat various cancers including breast, gastric, kidney, cervical, endometrial, colon, lung, head and neck, and brain cancer; multiple myeloma (a type of cancer of the bone marrow); osteoporosis (a condition in which the bones become thin and weak and break easily); acute myeloid leukemia (a type of cancer that begins in the white blood cells); and melanoma (a type of skin cancer).

The immune system attacks foreign substances by producing large numbers of antibodies, a protein that sticks to a specific protein called an antigen. Antibodies circulate throughout the body until they find and attach to the antigen. Once attached, they can force other parts of the immune system to destroy the cells containing the antigen.

Monoclonal antibodies are man-made proteins (made in the laboratory) by cloning a unique white blood cell that acts similar to human antibodies in the immune system. Monoclonal antibodies possess monovalent affinity, binding only to the same epitope (the part of an antigen that is recognized by the antibody) and can bind to substances in the body, including cancer cells.

Antineoplastic monoclonal antibodies are administered as a liquid or as a powder to be mixed with a liquid and injected intravenously (into a vein).

Antineoplastic monoclonal antibodies work in the following ways:

• They belong to a class of medications called “RANK ligand inhibitors” that work to prevent bone loss by blocking a certain receptor in the body to decrease bone breakdown.
• They treat high calcium levels by decreasing bone breakdown as the breakdown of bones releases calcium.
• They boost the immune response against cancer cells by binding to the CD52 antigen and attract immune cells to destroy cancerous cells.
• Cancer cells have large amounts of HER2 protein on their surface, and when HER2 is activated, it helps these cells to grow and spread.
• They bind to these proteins, thus inhibiting them from becoming active, eventually preventing the growth and spread of cancer cells.

Antineoplastic monoclonal antibodies are used to treat conditions such as:

• Breast cancer
• Metastatic colorectal cancer (cancer that begins in the large intestine)
• Non-small cell lung cancer
• Renal cell carcinoma (kidney cancer)
• Cervical cancer (cancer that begins in the opening of the uterus)
• Gastric cancer (cancer of the stomach)
• Ovarian, fallopian tube, or peritoneal cancer
• Glioblastoma (an aggressive type of cancer that can occur in the brain or spinal cord)
• Hepatocellular carcinoma (liver cancer)
• Advanced squamous cell carcinoma of head and neck
• Chronic lymphocytic leukemia (a type of cancer of the blood and bone marrow)
• Acute myeloid leukemia (a type of cancer that starts in the blood-forming cells of the bone marrow)
• Multiple sclerosis (a potentially disabling disease of the brain and spinal cord)
• Kidney transplantation
• Multiple myeloma (cancer that forms in a type of white blood cell called plasma cell)
• Amyloidosis (deposition of amyloid [abnormal protein] in the body)
• Osteoporosis (a condition in which the bones become brittle and fragile from loss of tissue, typically because of hormonal changes or deficiency of calcium or vitamin D)
• Aromatase inhibitor-induced bone loss
• Androgen deprivation-induced bone loss
• Glucocorticoid-induced osteoporosis
• Hypercalcemia of malignancy (high calcium level)
• Melanoma (a tumor of melanin-forming cells, especially a malignant tumor associated with skin cancer)
• Malignant pleural mesothelioma (a type of cancer that affects the inside lining of the lungs and chest cavity) 
• Classical Hodgkin’s lymphoma (a type of blood cancer)
• Urothelial carcinoma (cancer of the lining of the bladder and other parts of the urinary tract)
• Primary mediastinal large B-cell lymphoma (a type of non-Hodgkin’s lymphoma)
• Merkel cell carcinoma (a type of skin cancer) 
• Esophageal cancer (cancer that occurs in the esophagus — a long, hollow tube that runs from the throat to the stomach)
• Endometrial cancer (cancer begins in the layer of cells that form the lining [endometrium] of the uterus)
• Hairy cell leukemia (a type of cancer in which the bone marrow produces excess lymphocytes)
• Mycosis fungoides or sézary syndrome (a rare form of T-cell lymphoma of the skin)
• Castleman disease (a rare disorder that involves an overgrowth of cells in the body's lymph nodes)

Some of the common side effects include:

• Nausea
• Vomiting
• Diarrhea
• Abdominal pain
• Heartburn
• Loss of appetite
• Headache
• Tiredness/weakness
• Constipation
• Altered taste sensation
• Hot flushes
• Dryness of mouth
• Mouth sores
• Back, bone, joint, or muscle pain

Other rare side effects include:

• Dizziness 
• Fatigue 
• Hair loss
• Weight loss
• Chest pain
• Insomnia 
• Shortness of breath
• Chills, sore throat, fever, or cough
• Rash/hives/itching
• Blurred vision
• Peripheral edema (swelling of lower legs or hands)
• Numbness, tingling, pain, or burning in arms or legs
• Yellowing of the skin or eyes
• Muscle stiffness, twitching, cramps, or spasms
• Unusual bleeding or bruising
• Night sweats
• Depression

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand names of antineoplastic monoclonal antibodies include:

• Ado-trastuzumab emtansine
• Alemtuzumab
• Avastin
• Balstilimab (pending FDA approval)
• Bevacizumab
• Bevacizumab-awwb
• Bevacizumab-bvzr
• Campath
• Cetuximab
• Daratumumab
• Daratumumab/hyaluronidase
• Daratumumab/hyaluronidase-fihj
• Darzalex
• Darzalex faspro
• Denosumab
• Elotuzumab
• Empliciti
• Enhertu
• Erbitux
• Fam-trastuzumab deruxtecan-nxki
• Gemtuzumab
• Herceptin
• Herceptin hylecta
• Herzuma
• Ipilimumab
• Jemperli
• Kadcyla
• Kanjinti
• Keytruda
• Lemtrada
• Lumoxiti
• Mogamulizumab
• Mogamulizumab-kpkc
• Moxetumomab pasudotox
• Moxetumomab pasudotox-tdfk
• Mvasi
• Mylotarg
• Nivolumab
• Ogivri
• Ontruzant
• Opdivo
• Oportuzumab monatox (pending FDA approval)
• Panitumumab
• Pembrolizumab
• Perjeta
• Pertuzumab
• Poteligeo
• Prolia
• Siltuximab
• Sintilimab
• Sylvant
• Trastuzumab
• Trastuzumab deruxtecan
• Trastuzumab-anns
• Trastuzumab-dkst
• Trastuzumab-dttb
• Trastuzumab-hyaluronidase-oysk
• Trastuzumab-pkrb
• Trastuzumab-qyyp
• Trastuzumab/hyaluronidase
• Trazimera
• Tyvyt
• Unituxin
• Vectibix
• Vicineum (pending Food and Drug Administration approval)
• Xgeva
• Yervoy
• Zirabev