4.1 monoclonal antibodies

Question 1

how can monoclonal antibodies be used in clinical practise?

Answer 1

in diagnostics

in therapeutics

Question 2

what is a monoclonal antibody?

Answer 2

monovalent antibodies which bind to the same epitope and are produced from a single B lymphocyte clone

Question 3

what are the three types of monoclonal antibodies?

Answer 3

naked monoclonal antibody
conjugated monoclonal antibody
bispecific monoclonal antibody

Question 4

how do monoclonal antibodies work?

Answer 4

bind with cell surface receptor to either activate or inhibit signalling within the cell

binding to induce death

binding with cell surface receptors to activate

• antibody dependent cell mediated cytotoxicity
• complement dependent cytotoxicity

internalization (i.e being taken in by cell via membrane) for antibodies delivering toxins into the cancer cell

blocking inhibitory effects on T cells (checkpoints), thus activating T cells to help ‘kill’ cancer cell.

Question 5

what receptors are expressed on B cells?

Answer 5

CD19 and CD20 in early B cells

Question 6

what type of cancer is lymphoma?

Answer 6

B and T cell neoplasms - clonal proliferations of lymphoid cells

typically causes enlargement of lymph nodes

Question 7

what symptoms do people with lymphoma typically present with?

Answer 7

night sweats, fevers and weight loss

some have none of these symptoms

Question 8

what is the difference between follicular and diffuse large B cell lymphoma?

Answer 8

follicular - small clonal B lymphocytes

diffuse large B cell - Large clonal B lymphocytes which take over the node in a diffuse pattern

Question 9

what are the treatment therapies in lymphoma?

Answer 9

chemotherapy
radiotherapy
monoclonal antibody therapy
emerging new targeted therapy
stem cell transplant 

in lymphoma, can give steroids and
RITUXIMAB ( a monoclonal antibody against CD20)

Question 10

what are the ADR of rituximab?

Answer 10

some may have no or mild symptoms e.g fatigue

may have a reaction to the first infusion and then tolerate subsequent treatments well

a few people will have severe infusion related reactions as their immune system reacts to the presence of a foreign protein

Question 11

how can you try treat the ADRs of rituximab and other forms of monoclonal antibody therapies?

Answer 11

prior prophylaxis

• sterioids
• anti emetics
• hydrocortizone
• anti histamines
• paracetamol