The Oncologist, Vol. 2, No. 3, 188–188,
June 1997
© 1997 AlphaMed Press
SPECIAL FEATURE
BRIEF REPORT |
Monoclonal Antibodies: How to Use Them in Practice
Peter McLaughlin, M.D.
University of Texas M.D. Anderson Cancer Center, Department of Hematology, Box 68, 1515 Holcombe Boulevard, Houston, TX 77030-4009
Several recent trials of monoclonal antibodies for patients with B-cell lymphomas have been sufficiently successful to anticipate the more widespread availability of these agents in the near future. Several features that are fairly unique to monoclonal antibody therapy will be discussed, including: A) the allergic and immunologic manifestations that can occur with monoclonal antibodies, including the HAMA (human anti-mouse antibody) response with murine antibodies; B) issues for toxin conjugates, such as the need for internalization of the delivered toxin; C) dosimetry issues for radioimmunoconjugates, particularly when there is bone marrow involvement, and the associated risk of myelosuppression, and D) the consequent possible need for stem cell support.
Clinical results using the anti-CD20 antibody IDEC C2B8 will be discussed in some detail. IDEC C2B8 is a chimeric antibody with a human constant region of IgG1 kappa isotope; it is not conjugated to any isotope or toxin, so it probably acts largely through normal effector mechanisms such as complement-mediated lysis. This antibody has been found in a multi-institutional pivotal phase III trial to be both safe and effective. The overall response rate was 50%. The tolerance was very good. By virtue of its being a chimeric antibody, the HAMA response was negligible. On the schedule used (once weekly for four weeks), the treatment was completed in 22 days and was feasible on an outpatient basis.
