Alemtuzumab
(Campath)

CD52

Humanized, unconjugated

Chronic lymphocytic leukemia

Hematologic toxicity; opportunistic infections; rash; live vaccines should be avoided; herpes and pneumocystis prophylaxis recommended

CBC; CD4 counts

Bevacizumab (Avastin)

VEGF

Humanized, unconjugated

Colorectal cancer, non-small cell lung cancer (non-squamous); glioblastoma

Gastrointestinal perforation; wound healing complications; hemorrhage; arterial and venous thromboembolism; proteinuria; hypertension; discontinue use several weeks before elective surgery; do not restart until surgical incision has healed

Urinalysis; blood pressure

Cetuximab (Erbitux)

EGFR

Chimeric, unconjugated

Colorectal cancer, head and neck cancers

Acneiform rash; diarrhea; hypomagnesemia; nausea and vomiting; interstitial lung disease (rare)

Electrolyte levels; signs of inflammatory and infectious sequelae in patients with dermatologic toxicity; signs of pulmonary toxicity

Gemtuzumab ozogamicin (Mylotarg)

CD33

Humanized, toxin conjugate (calicheamicin)

Acute myeloid leukemia

Severe myelosuppression; hepatotoxicity

CBC; electrolyte levels; LFTs

⁹⁰Y-Ibritumomab tiuxetan (Zevalin)

CD20

Murine, radioisotope conjugate (yttrium-90)

Non-Hodgkin's lymphoma

Severe, prolonged myelosuppression; severe mucocutaneous reactions (e.g., Stevens-Johnson syndrome); risk of secondary malignancies (e.g., acute myeloid leukemia); radiation safety precautions required for one week after administration*

CBC; pretreatment antibody titers in patients who have received other murine-based radioimmunotherapy regimens

Ofatumumab

(Arzerra)

CD20

Human, unconjugated

Chronic lymphocytic leukemia

Lymphocytopenia; HBV reactivation (titers must be checked prior to initiating therapy); Monitor neurological function (progressive multifocal leukoencephalopathy, PML); Infusional reactions; pneumonia

CBC and LFTs; signs of active HBV infection or hepatitis in patients who are HBV carriers

Panitumumab

(Vectibix)

EGFR

Human, unconjugated

Colorectal cancer

Acneiform rash; diarrhea; hypomagnesemia; hypocalcemia; nausea and vomiting; interstitial lung disease (rare)

Electrolyte levels; signs of inflammatory and infectious sequelae in patients with dermatologic toxicity; signs of ocular toxicity (e.g., conjunctivitis, ocular hyperemia, increased lacrimation, eye or eyelid irritation)

Rituximab (Rituxan)

CD20

Chimeric, unconjugated

Non-Hodgkin's lymphoma; rheumatoid arthritis

Lymphocytopenia; HBV reactivation (titers must be checked prior to initiating therapy); severe mucocutaneous reactions (e.g., Stevens-Johnson syndrome); live vaccines should be avoided

CBC and LFTs; signs of active HBV infection or hepatitis in patients who are HBV carriers

¹³¹I-Tositumomab (Bexxar)

CD20

Murine, radioisotope conjugate (iodine-131)

Non-Hodgkin's lymphoma

Hypothyroidism; severe, prolonged myelosuppression; nausea and vomiting; secondary malignancies (e.g., acute myeloid leukemia; radiation safety precautions required for one week after administration*

CBC; pretreatment antibody titers in patients who have received other murine-based radioimmunotherapy regimens

Trastuzumab (Herceptin)

HER2/neu

Humanized, unconjugated

Breast cancer with HER2/neu overexpression

Cardiomyopathy (especially if co-administered with anthracycline chemotherapy); cytopenias; rash

Must evaluate pre-treatment LVEF (e.g., MUGA scan)

Note: All monoclonal antibodies are administered intravenously. Infusion reactions may occur with all monoclonal antibodies (more often with murine and chimeric antibodies) and are not listed as toxicities.

Abbreviations: FDA = U.S. Food and Drug Administration; CD = cluster of differentiation; CBC = complete blood count; VEGF = vascular endothelial growth factor; LVEF = left ventricular ejection fraction; LFTs = liver function tests; EGFR = epidermal growth factor receptor; HBV = hepatitis B virus.

*Radiation precautions include careful disposal of body fluid-contaminated material, condom use for sexual relations, and hand washing.