Biotherapy

May be defined as treatment with agents derived from biologic sources and/or affecting biologic responses. Many agents were derived from mamalian genome. The explosion of biotherapy research and technologic advances has lead to the use of numerous agents, both commercially and in clinical trials.

Historical Perspective
The immunotherapy of cancer can be divided into two approaches, active and passive. Active immunotherapy consists of giving a tumor-bearing host agents that are designed to elicit an immune response capable of retarding or eliminating tumor growth. Two types of active immunotherapy Active specific immunotherapy. Is an immunization with tumor cells or tumor cell extracts, such as proteins or gangliosides administered as tumor antigens, or vaccines. Passive immunotherapy. Is the administration or transfer of previously sensitized immunologic reagents such as antisera or immune reactive cells to at tumor bearing host Adoptive immunotherapy. Refers to the passive transfer of sensitized cells such as lymphocytes or macrophages

Reference: Oncology Nursing 5 edition by Langhorne, Fulton & Otto page 377

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Principles of Biotherapy
Biotherapy encompasses more than just the immune system. It includes treatments affecting other biologic responses such as growth and differentiation factors, chimeric molecules, and agents that may affect the ability of tumor cells to metastasize. Early trials failed to establish immunotherapy as a major modality as a result of the lack of the lack purity and definition of immunotherapeutic agents, the lack of analogy between animal-model and inadequate administration of immunotherapeutic agents.

Major Agents Used

Inteferons It is used to treat several malignancies and viral diseases. The antiviral activity of inteferons renders uninfected cells resistant to attack by the offending virus as well as by a variety of other viruses. Lymphokines Interleukins It is a glycoprotein produced by activated T-helper cells, a potent modulator of immune responses. Hematopoeitic growth factors Are a family of glycoproteins responsible for the proliferation, differentiation, and maturation of hematopoetic cells in vitro. They also stimulate functions of certain mature leukocytes. Sargramstim. Is a glycoprotein that shortens time to neutrophil recovery following chemotherapy administration Filgrastim. Its initial indication was to reduce the incidence of infection in patients with nonmyeloid malignancies who were receiving immunosuppressive anticancer drugs associated with a significant incidence of severe neutropenia with fever. Pegfilgrastim. A polyethylene glycol molecule attached to the filgrastim, it is used to increase irs action to permit once-per-cycle dosing Epoetin alfa. Used for treatment of anemia to patients undergoing chemotherapy Darbepoeitin alfa. Next generation of erythropoietin for treatment of chemotherapy induced anemia in patients with nonmyeloid malignancies. Also a recombinant human erythropoietin with longer half life than epoetin alfa

Oproveklin. It stimulates the growth and development of megakaryocytes and platelets. It is also used to prevent severe chemotherapy-induced thrombocytopenia and to reduce the need for platelet transfusions following myelosuppressive chemotherapy in patients with nonmyeloid malignancies

Monoclonal Antibodies An antigen is a substance that the body recognizes as foreign and attacks with an immune response. The humoral immune response produces immunoglobulins against the invading antigen from B-cell derived plasma cells. These immunoglobulins reacts specifically with the antigenic determinants or epitopes of the reducing antigen recognized by the antibodies. Each antigen has many number of epitopes, depending on the complexity of its structure. Individual B-cells produce an antibody specific for single antigenic determinants; therefore, when an antigen invades the body, a variety of antibodies against it are produced. These cells are called monoclonal antibodies

Radioimmunotherapy It combines radioactive isotopes such as iodine 131 and yttrium 90 with a Monoclonal antibody. The radioisotope is carried to the tumor by the monoclonal that attaches to a specific antigen present on the tumor cells surface. Once at the tumor site, 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, the biologic effects of monoclonal antibodies and the cross fire effect of the radiation on nearby tumor cells to which the antibody didnt bind. Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors Is a growth-promoting protein found on the surface of many different types of tumor cells, including lung, breast, and colon cancers. EGFR turosine kinase inhibitors are responsible for activating multiple downstream signalling pathways governing tumor growth.

Angiogenesis Inhibitors Angiogenesis is the process of blood vessel formation. Uncontrolled angiogenesis is pathologic and leads to the development and progression of malignant tumors. Angiogenesis inhibitors are a class of drugs that inhibit formation of blood vessels, thus cutting off the supply of nutrients and oxygen to malignant tumors, resulting in their death.

Considerations for Older Adults

Biotherapeutic agents are generally well tolerated by geriatric patients. Most of them are given on an outpatient basis. Many elders live alone and may have limited resources, it is very important to assess their functional status, economic status and support systems before initiating treatment. For elderly patients receiving self-injection biotherapy, it is critical to assess both their ability and their willingness to learn as well as any physical capabilities that may inhibit their ability to learn. Hepatic and renal function should be assessed before and during treatment with most biologic agents. Elderly patients may be at greater risk for cardiac complications, necessitating dose reductions or discontinuation of treatment. CNS associated side effects includes; confusion, memory loss, and diminished thought processes, must also be closely monitored. Fatigue is a significant side effect, skin toxicities may be more prevalent in the geriatric patient because of decreased tissue, skin, and mucous membrane integrity.