How Do Biological Response Modifiers Work?

Biological response modifiers (BRM) are drugs used to treat bladder cancer, reduce the frequency and severity of serious infections because of chronic granulomatous disease (an inherited immune system disease), renal cell carcinoma, hepatitis B and C infections, and Kaposi's sarcoma (a type of cancer that causes abnormal tissue growth on different parts of the body) related to acquired immunodeficiency syndrome.

BRM, also called immunotherapy, is a type of treatment that mobilizes the body's immune system to fight cancer. They can be both endogenous (produced naturally within the body) and exogenous (pharmaceutical drugs), and they can either enhance an immune response or suppress it.

BRMs are administered as a powder in a vial to mix with liquid and as a solution to inject either subcutaneously (under the skin), intramuscularly (into a muscle), intravenously (into the vein), or intralesionally (into a lesion).

BRMs work in the following ways:

• They belong to a class of medications called “immunomodulators” that work by modifying the immune system to fight cancer cells.
• They also belong to a class of drugs known as “cytokines.” They are a man-made version of a naturally occurring protein that stimulates the body to produce other chemicals which increase the body's ability to fight cancer.

Biological response modifiers are used to treat conditions such as:

• Chronic granulomatous disease (a disorder that causes the immune system to malfunction, resulting in a form of immunodeficiency)
• Malignant osteopetrosis (an inherited bone disease)
• Metastatic renal cell carcinoma (a type of cancer that begins in the kidney) 
• Metastatic melanoma (a type of skin cancer)
• Carcinoma in situ of the urinary bladder
• Papillary tumors (a tumor that looks like long, thin “finger-like” growths) 
• Hairy cell leukemia (a rare type of blood and bone marrow cancer that affects B lymphocytes)
• Follicular lymphoma (cancer that affects white blood cells called lymphocytes)
• Condylomata acuminata (anogenital warts caused by human papillomavirus)
• AIDS-related Kaposi's sarcoma (cancer that develops from the cells that line the lymph or blood vessels)
• Acute/chronic hepatitis C
• Chronic hepatitis B

Some of the common side effects include:

• Nausea
• Vomiting
• Dryness of mouth
• Altered taste sensation
• Back pain
• Diarrhea
• Muscle or joint pain
• Mouth sores
• Abdominal pain
• Headache
• Tiredness/weakness
• Loss of appetite
• Pain/swelling/bleeding/redness/irritation at the injection site

Other rare side effects include:

• Dizziness 
• Hair loss
• Fatigue 
• Insomnia 
• Chills, sore throat, fever, or cough
• Rash/hives/itching
• Swelling of the arms, hands, feet, ankles, or lower legs
• Yellowing of the skin or eyes
• Hypotension (low blood pressure)
• Oliguria (production of abnormally small amounts of urine)
• Thrombocytopenia (low blood platelet count)
• Increased creatinine 
• Confusion
• Tachycardia (heart rate over 100 beats per minute) 
• Hematuria (presence of blood in urine)
• Anemia (low red blood cell count)
• Weight gain

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 biological response modifiers include:

• Actimmune
• Aldesleukin
• BCG intravesical live
• Instilidrin (pending Food and Drug Administration approval)
• interferon alfa 2b
• Interferon alfa-2b
• interferon gamma 1b
• Interleukin 2
• Intron A
• Nadofaragene firadenovec
• Proleukin
• Tice BCG