Immunomodulators and Immunostimulants

Question 1

IL-2, Aldeslukin

Answer 1

1. MOA: stimulates production and activity of T cells, increases number of B cells and stimulates macrophages, increases NK cell activity, induces IFN gamma production.
2. Kinetics: IV admin
3. SE: Must be admin in hospital due to serious toxicity. Look at the sheet cause theres a ton of shit, pretty much anything you can think of is an SE.
4. CI: known hypersensitivity to IL-2
5. Use: metastic renal cell carcinoma, malignant melanoma

Question 2

Oprelvekin, rh-IL-11

Answer 2

1. MOA: recombinant IL-11
2. Kinetics: SubQ admin
3. SE: fluid retention, peripheral edema, moderate decreases in hemoglobin are possible
4. Use: prevent severe chemo-induced thrombocytopenia and reduce platelet transfusion need post-myelosuppressive chemo.

Question 3

Granulocyte Colony-Stimulating Factor; Filgrastim

Answer 3

1. MOA: human recombinant G-CSF
2. Kinetics: SubQ (pegylated to provide slow-release depot) or slow IV infusion.
3. SE: most common is bone pain, local skin irritation at injection site.
4. USe: severe neutropenia post autologous hematopoeitc stem cell transplant, neutropenia due to cancer chemo or interferon therapy, reduce neutropenia due to Zidovudaine

Question 4

Epoetin alfa, Darbopoetin alfa

Answer 4

1. MOA: recombinant human EPO, acts on EPO receptors on red cell progenitors to stimulate erythroid production,.
2. Use: anemia due to chemo when Hgb

Question 5

Interferon alfa-2a/2b

Answer 5

Used to tx chronic Hep C with reibavirin and protease inhibitors. Approved to tx hairy cell leukemia, karposi sarcoma, codylomata acuminata (injected into wart)

Question 6

Interferon Alfa-n3

Answer 6

Used to Tx condylomata acuminata and tx hep C in pts refractory to IFN-2a/2b

Question 7

Interferon beta 1-b

Answer 7

Suppresses class II MHC presentation and decreases antigen presentation in nervous system, decreases occurrence of exacerbation of relapsing-remitting MS, IFN-B-1a is also approved for tx of MS.

Question 8

Interferon gamma-1b

Answer 8

Potent phagocyte-activating effects: enhances killing of bacterial and protozoan pathogens; enhances superoxide production in macrophages, activates neutrophils, NK cells, potentiates effects of TNFa.
Increases T cell proliferation in response to Th1; increases MHC I and II. More potent than alfa and beta interferons. Used to reduce infection severity associated with chronic granulomatous disease.
2. SubQ

Question 9

SE of IFN treatment

Answer 9

1. CI in pts w/history of hypersensitivity to albumin or IFN
2. Depression is common (pretreat with antidepressents)-most deaths are due to suicide with these
3. confustion/fatigue
4. flu-like symptoms
5. Injection site rxns
6. Bone marrow suppression
7. Alopecia.
8. Increase in serum TGs>400 may predispose to pancreatitis
9. Increase in ALT greater than 2-5x baseline may require discontinuation.