9. BIOLOGIC RESPONSE MODIFIERS

Biologic Response Modifiers (BRMs)

also known as immunotherapies, are a class of treatments that work by enhancing, directing, or restoring the body's immune system to fight diseases, particularly cancer. They can either directly kill cancer cells (targeted therapy) or indirectly stimulate the immune system to do so. BRMs are also used to manage the side effects of other cancer treatments. While typically boosting the immune system, some BRMs can also suppress it depending on their specific action.

Interferons (IFNs)

Naturally occurring proteins, also produced synthetically, that slow the growth of cancer cells or make them behave more normally

Interferon alpha-2b (IFN-α-2b)

Interferons (IFNs)

• Route: IV, IM, SQ

• Source: B-lymphocyte cells, non–B- and non–T-lymphocyte cells, and macrophages.

• Indications: AIDS-related Kaposi sarcoma, malignant melanoma, Hepatitis B (HBV), Hepatitis C (HCV), Human Papillomavirus (HPV).

• Side Effects: Flu-like symptoms, chest pain, fatigue, depression, drowsiness, irritability, insomnia.

Interferon Beta (IFN-β)

Interferons (IFNs)

• Route: IM, SQ

• Source: Fibroblasts, macrophages, and epithelial cells.

• Indications: Treatment of Multiple Sclerosis (MS).

• Side Effects: Tight muscles, dizziness, numbness, tingling, joint pain, eye problems, runny nose, toothache, bruising, pain, redness, swelling, bleeding, seizures, dark brown urine, red or bloody stools

Interferon gamma (IFN-γ)

Interferons (IFNs)

• Route: SQ

• Source: Activated T lymphocytes and Natural Killer Cells (NKCs) endogenously; genetically produced from Escherichia coli.

• Indications: Chronic granulomatous disease and osteopetrosis.

• Side Effects: Extreme tiredness, diarrhea, nausea, vomiting, muscle or joint pain, dizziness, problems with walking, confusion, bruising, redness, swelling, bleeding, or irritation at the injection site.

• STOP Treatment Immediately for: Rash, itching, difficulty breathing or swallowing, hives, swelling of the eyes, face, mouth, tongue, and throat

Colony Stimulating Factors (CSFs)

Proteins that stimulate or regulate the growth, maturation, and differentiation of bone marrow stem cells, thereby promoting the production of blood cells, which can help patients continue with chemotherapy

Erythropoietin (EPO)

Colony Stimulating Factors (CSFs)

• Route: SQ, IV

• Action: Stimulates the division and differentiation of committed Red Blood Cell (RBC) progenitors in the bone marrow.

• Side Effects/Adverse Events: Hypertension, arthralgia, thromboembolism, bronchospasm.

Erythropoietin-Stimulating Agents (ESAs) - Epoetin Alfa

Colony Stimulating Factors (CSFs)

• Route: SQ, IV

• Action: Used when blood transfusions are not an option; stimulates RBC production in the bone marrow.

• Side Effects: Injection site reaction, myalgia, arthralgia, cephalgia, hypokalemia.

• Adverse Reactions: Anaphylactoid reactions, bronchospasm, Myocardial Infarction (MI), seizure, stroke, thromboembolism, hypertension.

Granulocyte Colony–Stimulating Factor (Filgrastim)

Colony Stimulating Factors (CSFs)

• Route: IV, SQ

• Action: Stimulates proliferation, differentiation, and functional activity of neutrophils, leading to a rapid rise in White Blood Cells (WBCs) and reducing the incidence of infection in patients.

• Side Effects: Nausea, vomiting, arthralgia, alopecia, diarrhea, fever, fatigue, skin rash, anorexia, cephalgia, cough, chest pain, sore throat, constipation, dizziness, dyspnea.

• Adverse Reactions: MI, Acute Respiratory Distress Syndrome (ARDS), splenic rupture, capillary leak syndrome, anaphylactoid reactions, glomerulonephritis, pulmonary bleeding/alveolar hemorrhage, cutaneous vasculitis.

• Contraindication: Do not administer within 24 hours of cytotoxic chemotherapy.

Colony Stimulating Factors (CSFs)

group of signaling-molecule proteins produced by leukocytes (T lymphocytes) that increase the growth and activity of other T and B cells, thereby affecting the immune response

Aldesleukin

Colony Stimulating Factors (CSFs)

• Route: IV, Subcut

• Indications: Metastatic renal cancer and metastatic melanoma.

• Important Note: Do not administer dexamethasone during treatment unless absolutely necessary.

• Side Effects: Capillary leak syndrome, hyperglycemia, diabetes, metabolic and respiratory acidosis, and electrolyte imbalance.

• Contraindications: Cardiac disease, coma, capillary leak syndrome

Nursing Process for Biologic Response Modifiers

• Assessment (A):

  • Obtain a current medication history and assess for drug and food allergies.

  • For ESAs, assess serum ferritin and serum iron-transferrin saturation.

• Diagnosis (D):

  • Potential for Injury.

  • Risk for Infection.

  • Deficient Knowledge related to the immunotherapy regimen.

• Planning (P):

  • Patient will remain free from infection.

  • Patient will demonstrate understanding of immunotherapy as part of their anticancer treatment regimen.

• Implementation (I):

  • Monitor for chest pain and ECG changes.

  • Monitor for bleeding.

  • Assess renal and hepatic function.

  • Administer Acetaminophen to reduce chills and fever.

  • Administer Diphenhydramine to reduce histamine effects.

  • Ensure resuscitative treatment is on standby.

  • Explain the immunotherapy in layman’s terms to the patient.

• Evaluation (E):

  • Patient remains free of further injury.

  • Side effects are managed effectively.