Appendix
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Oncology/Immunology

Monoclonal Antibodies in Clinical Practice

Modern-day medicine has been revolutionized to be personalized and specific based on individualized specific disease characteristics. Monoclonal antibodies (mAbs) are a prime example of personalized therapeutics enabled by advances in our knowledge of immunology, molecular biology, and biochemistry. As an example, a disease such as cancer can be evaluated for the presence of certain properties (i.e., hormone receptors in breast cancers), which can, in turn, be targeted by mAbs to provide a "tail

v1 · Reviewed Nov 7, 2026 by Automated Clinical Reviewer (Strict Verbatim v1)
  • Anaphylaxis is an immediate hypersensitivity reaction (type 1) that can also occur when using mAbs.
  • In severe reactions with multiple organ failure, cessation of the offending medication and commencement of supportive measures (i.e., mechanical ventilation, IV fluids, vasopressors, HD, etc.) is necessary.
  • The increased clearance due to HAMA generation was also accompanied by eventual Immunoglobulin E (IgE) development and anaphylactic reactions on subsequent administrations.
  • Once inhibition of TNF-a occurs (for example, by administration of mAbs), the bacteria’s confinement is compromised, and reactivation of latent infection occurs.
  • biologics act by inhibiting the host's immune function and thereby lower the body’s defense mechanisms, potentially predisposing recipients to opportunistic infections, atypical infections (i.e., fungal), and sepsis.
  • Infusion-related reactions typically occur during administration or within hours of administration of mAb infusions but may occur later.
  • a disease such as cancer can be evaluated for the presence of certain properties (i.e., hormone receptors in breast cancers), which can, in turn, be targeted by mAbs to provide a "tailored" therapy.
  • Inflamed joints in RA patients have demonstrated elevated TNF-a content within the synovium, which effectively correlates with disease activity.
  • the use of TNF-a inhibitors such as Adalimumab warrants the additional step of ensuring that the patient does not have underlying latent tuberculosis (TB).
  • The dysfunction of these mechanisms can lead to reduced growth and eventual apoptosis of malignant cells.
  • Immune-mediated cell destruction is another mechanism by which mAbs have been applied in oncology.
  • Adalimumab has demonstrated a reduction in inflammatory cytokines (IL-1, IL-6, IL-8, granulocyte-macrophage colony-stimulating factor (GM-CSF)) and acute-phase reactants (i.e., erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)), providing effective treatment for patients with RA who meet criteria to receive mAb therapy
  • In more mild cases, the infusion can be temporarily interrupted, and supportive medications (for example, diphenhydramine and paracetamol) can be given before restarting the infusion at slower rates.
Adalimumab
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diphenhydramine
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paracetamol
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  • Chimeric clones were the next developments, whereby human crystallizable fragment (Fc) regions were attached in place of murine ones.
  • Examples of chimeric mAbs include infliximab and rituximab.
  • Chimeric clones were followed by developing "humanization," a process where murine protein loops (which served as ligand binding sites) were implanted within human immunoglobulins.
  • Examples of humanized mAbs include Daclizumab and trastuzumab.
  • The culmination of all methodologies has led to present-day mAbs production capable of producing fully human mAbs and minimizing the risks originally associated with their predecessors.
  • An example of mAbs generated by recombinant DNA methodologies includes adalimumab.
  • The management of mAb-associated anaphylaxis does not differ from the management of anaphylaxis due to other agents.
  • The increased clearance due to HAMA generation was also accompanied by eventual Immunoglobulin E (IgE) development and anaphylactic reactions on subsequent administrations.
  • Type alpha reactions refer to high cytokine and cytokine release syndrome reactions.
  • Type beta reactions are allergy-type reactions that may be mediated by IgE, IgG, or T-cells (immediate vs. delayed).
  • Type gamma reactions are termed cytokine or immune imbalance syndromes that can lead to autoimmunity, allergic/atopic disorders, or impaired immune function.
  • Type delta reactions refer to cross-reactivity reactions that can occur when targeted antigens are also expressed on other cells/ structures.
  • Type epsilon reactions refer to non-immunologic adverse effects.
  • Infusion-related reactions typically occur during administration or within hours of administration of mAb infusions but may occur later.
  • As with other infusion-related reactions, the severity of reactions will dictate management options.
  • review
    Monoclonal Antibodies in Clinical Practice. StatPearls [Internet] — Bilal Malik, Abhijeet Ghatol — StatPearls Publishing, 2023

Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov