Monoclonal Antibodies

Question 1

What is the brand name of Trastuzumab?

Answer 1

The brand name of this generic drug is:
- Herceptin

Question 2

What is the brand name of Cetuximab?

Answer 2

The brand name of this generic drug is:
- Erbitux

Question 3

What is the brand name of Panitumumab?

Answer 3

The brand name of this generic drug is:
- Vectibix

Question 4

What is the brand name of Pertuzumab?

Answer 4

The brand name of this generic drug is:
- Perjeta

Question 5

What is the brand name of Bevacizumab?

Answer 5

The brand name of this generic drug is:
- Avastin

Question 6

What is the brand name of Daratumumab?

Answer 6

The brand name of this generic drug is:
- Darzalex

Question 7

What is the brand name of Rituximab?

Answer 7

The brand name of this generic drug is:
- Rituxan

Question 8

What is the generic of name of Herceptin?

Answer 8

The generic name of this brand name drug is:
- Trastuzumab

Question 9

What is the generic of name of Erbitux?

Answer 9

The generic name of this brand name drug is:
- Cetuximab

Question 10

What is the generic of name of Vectibix?

Answer 10

The generic name of this brand name drug is:
- Panitumumab

Question 11

What is the generic of name of Perjeta?

Answer 11

The generic name of this brand name drug is:
- Pertuzumab

Question 12

What is the generic of name of Avastin?

Answer 12

The generic name of this brand name drug is:
- Bevacizumab

Question 13

What is the generic of name of Darzalex?

Answer 13

The generic name of this brand name drug is:
- Daratumumab

Question 14

What is the generic of name of Rituxan?

Answer 14

The generic name of this brand name drug is:
- Rituximab

Question 15

What is the general MOA of the Monoclonal Antibodies class?

Answer 15

The MOA of this drug class is as follows:
- Bind to specific targets (immune cells. cell receptors. tumor molecules. etc.) to exert anti-tumor effects, the specific target varies per antibody.
- This leads to very specific anti-tumor effects using biologic agents.

Question 16

What are the notable monitoring parameters for Daratumumab?

Answer 16

The notable monitoring parameters for this drug are:
- Type and screen prior to starting therapy (this drug can affect the ability to determine a patient’s blood type if a transfusion is needed)

Question 17

What are the notable monitoring parameters for Bevacizumab?

Answer 17

The notable monitoring parameters for this drug are:
- Blood pressure and urine protein prior to starting therapy and periodically during treatment

Question 18

What are the notable monitoring parameters for Trastuzumab?

Answer 18

The notable monitoring parameters for this drug are:
- Assess left ventricular ejection fraction at baseline, every 3 months during therapy, every 4 weeks if therapy is withheld for significant left ventricular cardiac dysfunction, and every 6 months for at least 2 years following completion of therapy

Question 19

What are the notable monitoring parameters for Pertuzumab?

Answer 19

The notable monitoring parameters for this drug are:
- Assess left ventricular ejection fraction at baseline, every 3 months during therapy, every 4 weeks if therapy is withheld for significant left ventricular cardiac dysfunction, and every 6 months for at least 2 years following completion of therapy

Question 20

What are the notable/common monitoring parameters for the Monoclonal Antibodies class?

Answer 20

The notable/common monitoring parameters for this drug class are:
- Hepatitis B screening prior to starting therapy (patients may need hepatitis B prophylaxis if positive)

Question 21

Describe the overall emetic potential of the Monoclonal Antibodies class.

Answer 21

The emetic potential of this drug class is:
- Minimal

Question 22

Describe the overall extravasation risk and management strategies for the Monoclonal Antibodies class.

Answer 22

The extravasation risk and management strategies for this drug class are as follows:
- None, N/A

Question 23

Describe the overall metabolism of the Monoclonal Antibodies class.

Answer 23

The metabolism of drugs in this class is as follows:
- Generally, agents undergo intracellular lysosomal degradation

Question 24

What are the notable/common ADRs of the Monoclonal Antibodies class?

Answer 24

The notable/common ADRs of this drug class are:
- Infusion Reactions

Question 25

Describe the strategy and rationale for management of infusion reactions caused by Monoclonal Antibodies.

Answer 25

The strategy and rationale for management of this condition caused by this drug are:
- Infusion reactions occur due to the immunogenicity of these agents, this can lead to the development of anti-monoclonal antibodies, which can cause acute hypersensitivity reactions.
- The risk of reaction varies depending on the species whose proteins form the base of the molecule. Even fully humanized antibodies can cause allergic reactions.
- Infusion reactions typically occur in the first 1-2 hours of starting an infusion. They can affect any organ system and range from mildly irritating injection-site reactions, fever or itching/rash to potentially life-threatening anaphylaxis.
- Mild reactions are common. Many patients will receive premedication with acetaminophen and diphenhydramine prior to their infusion.
- In the event of an infusion reaction, always stop the infusion as soon as possible. From there, treatment depends on the severity of the reaction.
- After a mild reaction (slight rash or itching), the infusion can often be continued after temporarily stopping it with a slower infusion rate or additional doses of antipyretics or antihistamines.
- More severe reactions (like anaphylaxis) can be managed with epinephrine and may require permeant discontinuation of the drug.
- Humanized antibodies are produced by merging the DNA that encodes the binding protein of a monoclonal mouse antibody with human antibody producing DNA. This can reduce the risk of hypersensitivity reactions.

Question 26

Describe the half-life of the Monoclonal Antibodies class.

Answer 26

The half-life of the this drug class is described as follows:
- These agents typically have a long half-life (many are >15 days)
- This often leads to a slower onset of actions (many antibodies can take at least a several weeks before a meaningful effect is achieved)

Question 27

What are the clinical pearls of the Monoclonal Antibodies class?

Answer 27

The clinical pearls of this drug class are as follows:
- These agents are very large proteins (molecular weight of ~146,000 Dal and therefore have poor CNS penetration

Question 28

Describe the naming conventions of the Monoclonal Antibodies class.

Answer 28

The naming conventions of this drug class are as follows:
- Chimeric monoclonal antibodies contain “-xi-“ (ex. Cetuximab)
- Humanized monoclonal antibodies contain “-zu-“ (ex. Trastuzumab)
- Fully human antibodies contain “-u-“ (ex. Panitumumab)