Monoclonal antibodies for the treatment of non-hematological tumors: a safety review

ABSTRACT

Introduction: The introduction of monoclonal antibodies (moAbs) into clinical practice revolutionized the treatment strategies in several solid tumors. These agents differ from cytotoxic chemotherapy for their mechanism of action and toxicity. By targeting specific antigens present on healthy cells and modulating immune system activity, these biological drugs are able to generate a wide spectrum of peculiar adverse events that can negatively impact on patients’ quality of life.

Areas covered: In this review, the main side effects associated with the use of moAbs have been described to show their incidence and current management strategies, which may drive clinicians in their daily practice.

Expert opinion: The majority of these drugs represents an example of successful innovation, since they are able to induce a significant improvement of patients’ survival and quality of life without any increase in related side effects as compared to standard cancer treatments. For this reason, they have become new milestones in personalized therapy for different non-hematological malignancies. With the increasing use of moAbs in treatment regimens, it is strongly recommended that clinicians are knowledgeable about the side effects associated with these agents, their management and monitoring, to optimize the clinical treatment of cancer patients.

KEYWORDS:

• Adverse events
• CTLA-4
• EGFR
• HER-2
• immunotherapy
• moAbs
• PD-1
• PD-L1
• target therapy
• VEGF

Article highlights

• moAbs are able to induce a selective response against malignant cells due to their unique mechanism of action, representing a potential treatment option for different solid tumors such as ovarian, lung, colorectal, and breast cancers.

• The combination of moAbs with common cytotoxic chemotherapy has significantly improved the overall survival of different non-hematological malignancies.

• The current FDA-approved moAbs are anti-HER-2, anti-EGFR, anti-VEGF/VEGFR, anti-CTLA-4, and anti-PD1/PD-L1 agents.

• moAbs targeting the receptors expressed on the surface of non-neoplastic cells can lead to onset of several adverse events, different from those observed with standard chemotherapy, that can negatively impact on the patient’s quality of life.

• The knowledge of the guidelines for the toxicity management is important to recognize and promptly act on the most relevant adverse events, to optimize the clinical treatment of cancer patients.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper has not been funded.