Caring for the patient undergoing biological therapy

Published on 09/04/2015 by admin

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Last modified 09/04/2015

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12 Caring for the patient undergoing biological therapy

• To introduce the principles of biological therapy

• To understand the impact of biological therapy on the individual

Introduction

One of the most exciting and most recent developments in cancer treatments are the biological therapies. These have been developed as a result of the expansion of our knowledge of cancer biology. Many of these treatments are still in the trial phase and are still being investigated to optimise their effectiveness and to identify what side effects they may cause. However NICE has approved many of these treatments for general use. During your cancer/palliative care placement, you may come across patients receiving biological therapies alongside other cancer treatments such as cytotoxic therapy or radiotherapy. If you are allocated to a cancer centre, you may be able to arrange an insight visit with the clinical research team who coordinate and run cancer clinical trials.

Many of the treatments are administered orally and patients who are physically able will self-administer the drugs at home, so you may encounter the treatments while on a community placement or in the outpatient setting. Alternatively, if you have a placement in an inpatient area, try to find out what biological treatments some of your patients are on. Patients often confuse these drugs with cytotoxic therapy, but they act very differently and the side effects of biological therapies are variable in terms of the range of toxicities as well as the severity.

Biological therapies are treatments that use natural substances from the body, or drugs made from these substances. Biological therapies stimulate, direct or boost the body’s own immune cells to:

– attack or control the growth of cancer cells

– restore blood cells following an episode of cytotoxic-related neutropenia

– interfere with the way cells interact and signal to each other.

Read Waugh and Grant (2010) (see References) or a similar textbook to refresh your knowledge of the different parts and cells of the immune system. How does the immune system work to get rid of non-self cells?

NMC Domain 3: 3.2

There are numerous types of biological therapies. Table 12.1 identifies some of the main groups and provides examples of drugs/agents. Each group is discussed in turn.

Table 12.1 Types of biological therapies

Groups of biological therapies	Examples of agents
Cytokines	Interferon, interleukins, tumour necrosis factor, colony-stimulating factors (G-CSF: pegfilgrastim/filgrastim and epoetin alfa)
Monoclonal antibodies (MoAbs)	Trastuzumab (Herceptin), rituximab, bevacizumab, cetuximab
Cancer growth blockers	Tyrosine kinase inhibitors: erotinib (Tarceva), imatinib (Glivec), getitinib (Iressa), sunitinib, dasatinib, lapatinib Proteasome inhibitors: bortezomib (Velcade)
Anti-angiogenic agents	Thalidomide
Cancer vaccines	Bacillus Calmette–Guérin (BCG)
Gene therapies	In development

Cytokines

Cytokines are natural protein messengers secreted from blood cells that coordinate the immune system. They attach to a receptor on the surface of white blood cells and trigger them to multiply, recognise and deal with anything that is foreign to the body, such as a cancer cell, bacteria, etc.

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