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2 - Biological treatments in cancer

Published online by Cambridge University Press:  05 November 2015

Amy Quinton
South West Wales Cancer Centre, Singleton Hospital, Swansea, UK
Rachel Jones
Velindre Cancer Centre, Velindre Hospital, Cardiff, UK
Louise Hanna
Velindre Cancer Centre, Velindre Hospital, Cardiff
Tom Crosby
Velindre Cancer Centre, Velindre Hospital, Cardiff
Fergus Macbeth
Velindre Cancer Centre, Velindre Hospital, Cardiff
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The management of many cancers has changed as more biological agents have become available. For some, such as renal cell cancer and melanoma, in which chemotherapy has only limited effectiveness, targeted agents are now the mainstay of treatment. For others, where developments in chemotherapy have improved survival rates but increased toxicity, biological agents provide additional benefit with manageable toxicity, when alone or in combination with chemotherapy.

The licensed indications for new drugs are changing rapidly. A useful resource for up-to-date information can be found in the electronic Medicines Compendium (, accessed January 2015). However, although they are licensed, several of these biological agents are not available for routine use in the UK.

This chapter is an overview of the biological agents in current use in the UK, and covers their mode of action and side effects. Their specific clinical indications will be described in the individual tumour chapters. This chapter will concentrate on five areas:

  1. • protein kinase inhibitors and small molecule drugs,

  2. • monoclonal antibodies,

  3. • cytokines,

  4. • haemopoietic colony-stimulating factors, and

  5. • vaccines

Protein kinase inhibitors

Protein kinase inhibitors are predominantly oral agents, often with different, non-overlapping toxicities from chemotherapy, which allow them to be safely combined with chemotherapy and radiotherapy or to be given alone.

The targets for these drugs are the tyrosine and serine/threonine kinases. These enzymes transfer phosphate groups from ATP to specific amino acid residues on a protein through phosphorylation. The protein kinase inhibitors act by binding to the intracellular kinase region, directly competing with ATP, and thus preventing autophosphorylation. This in turn blocks the intracellular signalling cascades involved with the promotion of tumour growth, invasion, angiogenesis and resistance to apoptosis. They can be subdivided into receptor and non-receptor kinases.

The receptor kinase is an integral part of the receptor molecule spanning the cell membrane. Ligand binding to the receptor activates signalling pathways, and affects the activity of transcription factors and DNA synthesis. These include the epidermal growth factor receptor (EGFR), and the vascular endothelial growth factor receptor (VEGFR).

Publisher: Cambridge University Press
Print publication year: 2015

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Atkins, M. B., Kunkel, L., Sznol, M., et al. (2000). High-dose recombinant interleukin-2 therapy in patients with metastatic melanoma: long-term survival update. Cancer J. Sci. Am., 6(Suppl. 1), S11–14.Google ScholarPubMed
Ault, K. A. (2007). Effect of prophylactic human papillomavirus L1 virus-like-particle vaccine on risk of cervical intraepithelial neoplasia grade 2, grade 3, and adenocarcinoma in situ: a combined analysis of four randomised clinical trials. Lancet, 369, 1861–68.CrossRefGoogle ScholarPubMed
Citron, M. L., Berry, D. A., Cirrincione, C., et al. (2003). Randomized trial of dose-dense versus conventionally scheduled and sequential versus concurrent combination chemotherapy as postoperative adjuvant treatment of node-positive primary breast cancer: first report of Intergroup Trial C9741/Cancer and Leukemia Group B Trial 9741. J. Clin. Oncol., 21, 1431–39.CrossRefGoogle Scholar
Coppin, C., Porzsolt, F., Autenrieth, M., et al. (2004). Immunotherapy for advanced renal cell cancer. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD001425.CrossRefGoogle Scholar
Espinoza-Delgado, I. (2002). Cancer vaccines. Oncologist, 7(Suppl. 3), 20–33.CrossRefGoogle ScholarPubMed
Harper, D. M., Franco, E. L., Wheeler, C. M., et al. (2006). Sustained efficacy of up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised control trial. Lancet, 367, 1247–55.CrossRefGoogle ScholarPubMed
Harris, M. (2004). Monoclonal antibodies as therapeutic agents for cancer. Lancet Oncol., 5, 292–302.CrossRefGoogle ScholarPubMed
Janeway, C. A., Travers, P., Walport, M., et al. (2001). Immunobiology: The Immune System in Health and Disease, 5th edn. New York: Garland.Google Scholar
Lockyer, C. R. W. and Gillat, D. A. (2001). BCG immunotherapy for superficial bladder cancerJ. R. Soc. Med. 94, 119–23.CrossRefGoogle ScholarPubMed
NICE. (2014). Erythropoiesis‑stimulating agents (epoetin and darbepoetin) for treating anaemia in people with cancer having chemotherapy (including review of TA142) (TA323). London: National Institute for Health and Care Excellence.
Palmer, P. A., Vinke, J., Philip, T., et al. (1992). Prognostic factors for survival in patients with advanced renal cell carcinoma treated with recombinant interleukin-2. Ann. Oncol., 3, 475–80.CrossRefGoogle ScholarPubMed
Pfreundschuh, M., Trumper, L., Kloess, M., et al. (2004). Two-weekly or 3-weekly CHOP chemotherapy with or without etoposide for the treatment of young patients with good-prognosis (normal LDH) aggressive lymphomas: results of the NHL-B1 trial of the DSHNHL. Blood, 104, 626–33.Google ScholarPubMed
Rosenberg, S. A., Yang, J. C. and Restifo, N. P. (2004). Cancer immunotherapy: moving beyond current vaccines. Nat. Med., 10, 909–15.CrossRefGoogle ScholarPubMed
Rosevear, H. M., Lightfoot, A. J., O'Donnell, M. A., et al. (2009). The role of neutrophils and TNF-related apoptosis-inducing ligand (TRAIL) in bacillus Calmette–Guérin (BCG) immunotherapy for urothelial carcinoma of the bladderCancer Metast. Rev., 28, 345–53.CrossRefGoogle ScholarPubMed
Schenk-Braat, E. A. M. and Bangma, C. H. (2005). Immunotherapy for superficial bladder cancer.Cancer Immunol. Immun., 54, 414–23.CrossRefGoogle ScholarPubMed
Wick, J. (2004). What's in a drug name?J. Am. Pharm. Assoc., 44, 12–14.CrossRefGoogle Scholar

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