Monoclonal antibodies are a type of cancer immunotherapy that have been developed to target immune checkpoints. These checkpoints down-regulate programmed cell death 1 or apoptosis. Cancer immunotherapy to block these checkpoints may encourage apoptosis of cancer cells.
Pembrolizumab is a 'humanized monoclonal IgG4 kappa isotype antibody against PD-1'.[8] Pembrolizumab was approved by the FDA for “patients with unresectable or metastatic, microsatellite-instability–high (MSI-H) or mismatch-repair–deficient (dMMR) solid tumors, regardless of tumor site or histology”. [9] Pembrolizumab creates more objective tumor response among tumors in which at least 50% of its cells express PD-L1[8].
Nivolumab may case drug toxicity in about 40% of patients - rash and diarrhea are the most common effects[10].
These antibodies can activate the immune system to attack cancers. These antibodies target PD-L1, or cluster of differentiation 274 (CD274) which is the transmembrane protein ligand to PD-1.
The CTLA-4 Antigen is "an inhibitory T cell receptor that is closely related to CD28 antigen. It has specificity for CD80 antigen and CD86 antigen and acts as a negative regulator of peripheral T cell function. CTLA-4 antigen is believed to play role in inducing peripheral tolerance."[11]
Ipilimumab may cause autoimmune pituitary disease[12] and exacerbate autoimmune disease in recipients with pre-existing autoimmune disease[13]. The U.S. FDA has issued guidance on managing side effects.[14][15]
Raf inhibitors are "a family of closely-related serine-threonine kinases that were originally identified as the cellular homologs of the retrovirus-derived V-RAF kinases. They are MAP kinase kinase kinases that play important roles in signal transduction."[16]
↑ 1.01.1Schlom J, Gulley JL. Vaccines as an Integral Component of Cancer Immunotherapy. JAMA. Published online November 08, 2018. doi:10.1001/jama.2018.9511