Blinatumomab (Intravenous)

Blinatumomab is classified as a monoclonal antibody medicine for cancer therapy and it works like the body's immune system by detecting and attacking cancer cells.

Overview

Blinatumomab is administered by an intravenous injection, treating acute lymphoblastic leukemia (ALL), which occurs when bone marrow DNA cells fail to develop normal stem cells. Healthy bone marrow generates blood stem cells (immature cells) that mature into healthy blood cells. When the immature cells malfunction, they continue to grow and divide, creating abnormal cells that outnumber the healthy mature cells. The cause of DNA mutations is still unclear, since ALL disorders are not inherited.

As the cancerous cells enter the bloodstream, they spread to other organs, like the liver, spleen and lymph nodes. The symptoms are enlarged lymph nodes, severe bruising, bleeding gums, bone pain with fever and infections.

Blinatumomab treatment works with the body's natural response to a foreign substance (antigen) by producing antibodies to destroy the intruder. The antibodies attach to the antigen and deactivate it. As a monoclonal antibody, blinatumomab attaches itself to the antigen and destroys it. By differentiating normal from abnormal cells, this drug has been able to lower the threat of destruction to healthy cells.

Since every human body has thousands of different-shaped antibodies, the antibody has to match the particular shape of the antigen to attach and destroy it. If you or your child are diagnosed with this condition, your doctor will need to order tests to recognize the specific antigens and antibodies involved.

Although this disease is more common in children, it does also occur in adults.

Condition(s) treated

  • Acute lymphoblastic leukemia
  • Brain cancer
  • Breast cancer
  • Chronic lymphocytic leukemia
  • Colorectal cancer
  • Head and neck cancers
  • Hodgkin's lymphoma
  • Lung cancer
  • Melanoma
  • Non-Hodgkin's lymphoma
  • Prostate cancer
  • Stomach cancer

Type of medicine

  • Monoclonal antibody

Side effects

Before you start treatment, you need to have a discussion with the doctor and make sure you understand what's involved in treating this condition. 30% of patients experience side effects that are more common, less than 30% experience less than common effects, and fewer than 10% of patients experience rare or undocumented effects.

Blinatumomab lowers your white blood cell count, increasing the chance of infection. As a result, if you undergo this treatment, you will need to avoid individuals or groups of people with illnesses and environments that produce airborne germs or harmful bacteria. If you experience fever or chills, coughs or sore throats, body pains, trouble urinating, flu-like symptoms, shortness of breath, blood in your phlegm, sores on your body and warm or painful areas of your body, you may have an infection and should contact your doctor. Treatment may be slowed or delayed until you recover from the infection – it's a safe strategy, allowing your body to strengthen to battle the cancer the drug is treating.

It's important to talk with your doctor about any existing health disorders, medications (both prescription and non-prescription), diets, health supplements, herbal remedies and over the counter medicines that you are taking. All of these products may produce unwanted and uncomfortable side effects. Your doctor may have recommended solution to help diminish the effect or prevent them.

Neurotoxicity

Some individuals experience neurological sideeffects during some stage of the treatment. If you notice any of the following side effects, notify your doctor at once.

  • Confusion
  • Disorientation
  • Slurred speech
  • Difficulty talking
  • Loss of balance
  • Fainting

Sometimes the effect occurs at the beginning of treatment and fades away as your body adjusts to the medicine. Let your doctor know about annoying effects – there are solutions to help prevent and manage these conditions. Most side effects are predictable; your doctor can tell you when they occur, how long they last and the severity. Here is a list of common side effects:

  • Dizziness
  • Black, tarry stools, or blood in your stools
  • Blood, burning or pain in the urination
  • Colored urine
  • Dehydration
  • Diarrhea
  • Extreme fatigue
  • Nausea
  • Unusual bleeding or bruising
  • Upper abdominal pain
  • Vomiting
  • Yellowing of skin or eyes

Your experience may be different – the range of discomfort or pain varies, depending on your response to the medicine and your current health. Talk to your doctor or health teams – they can help you get through this phase of treatment.

More common

  • Bloating
  • Blurred vision
  • Chest pain
  • Cloudy urine
  • Confusion
  • Cough or hoarseness
  • Fever or chills
  • Hallucinations
  • Headache
  • Irritability
  • Loss of strength
  • Pale skin
  • Rash
  • Red spots on the skin
  • Seizures
  • Sore throat
  • Stiff neck
  • Stomach pain
  • Sweating
  • Swelling
  • Tingling of the hands or feet
  • Troubled breathing
  • Ulcers, sores, or white spots in the mouth
  • Unusual weight gain or loss

Less common

Side effects are part of the treatment and individual – your health care team can offer recommendations to reduce the effects. Be sure to keep them updated on the level of pain, because they can't help if they don't know. If you have questions about your response and treatments, ask your doctor.

  • Anemia
  • Back pain
  • Bone pain
  • Constipation
  • High blood sugar
  • Increased liver enzymes
  • Insomnia (sleep problems)
  • Low blood pressure (hypotension)
  • Low magnesium
  • Low platelet count (thrombocytopenia)
  • Low potassium
  • Low white blood cells
  • Weight gain
  • Decreased appetite

Some side effects will need medical attention, even though they are not an emergency. Keep in contact with your doctor to help check the effects of blinatumomab. Your doctor will schedule regular tests, checking your response to the drug and verifying your organs are functioning throughout treatment.

You may experinece other side effects not listed here. Always report side effects to your doctor or the treatment team, because the side effects influence your health and reaction to treatment.

Dosage

The dose of blinatumomab that you receive depends on several factors, including your own health, your weight, age, sensitivities to medicines and the stage of your cancer. Your doctor will decide the best volume of medicine and scheduling for treatment, based on the preliminary tests done earlier. This drug should not be used if the child weighs less than forty-eight pounds.

Blinatumomab treatment usually takes place in the hospital or a cancer treatment center. You have medical professionals close by to monitor the treatment. Your doctor may adjust the length of treatment if you have an adverse reaction or your health status causes a temporary delay in the treatment.

Treatment is given over a four-week cycle, followed by a two-week rest. The first and second cycle of treatments are administered under full supervision for observation of responses. Future cycles will follow the four-week on and two-week off schedule. After the second cycle, your doctor may adjust the dose of medicine or increase the treatment cycles contingent on how the disease is responding to treatment. Talk with your doctor to make sure you understand what's involved with treatment and why changes may need to be made.

Keep the area of IV injection clean to prevent infection.

Interactions

In all cases of treatment, there is some level of interaction between medicines – your doctor has the information about drugs reacting with blinatumomab. Using these known facts, your doctor may change the dose or frequency you take, or suggest an alternative as a precaution before starting treatment.

It's important to share your medical history and current health routines with your doctor. Over the counter medication may contain ingredients that interact with blinatumomab.

Here's a list of medications that interact with this drug. There may be others not listed. If you have questions, ask your doctor.

  • Alfentanil
  • Aminophylline
  • Artemether
  • Astemizole
  • Carbamazepine
  • Cisapride
  • Cyclosporine
  • Dihydroergotamine
  • Ergotamine
  • Fentanyl
  • Fosphenytoin
  • Iloperidone
  • Lumefantrine
  • Paclitaxel
  • Phenytoin
  • Pimozide
  • Quinidine
  • Sirolimus
  • Tacrolimus
  • Terfenadine
  • Theophylline
  • Warfarin

Lifestyles and health

Our diet and alcohol and tobacco use are choices we make each day. They can interact with this medicine, affecting its performance and your health. It's a good idea to sit down with your doctor and discuss what's best for you throughout this treatment and how to reap the benefits of this medicine.

Existing health conditions play a full role in recovery when being treated for this disease. If you have a history of these disorders, the condition could worsen. Your doctor needs to know about these ailments to protect your health. These are medical problems known to affect the responses to treatment:

  • Liver disease
  • Low number of white blood cells
  • Inflammation of the pancreas
  • Seizures
  • Infections
  • Vaccinations

Warnings

Warnings provide individuals undergoing treatment information about the risk factors associated with this drug. The information also helps health care professionals make sound decisions based on your individual health and past circumstances. Whether your treatment term is short or long, the warnings cite the contents of the medicine, identifying early signs to prevent unwanted health disorders before they develop into more serious.

This drug contains benzyl alcohol – it may cause fatal effects in newborns or infants.

One disorder occurring in patients with infusion chemotherapy of this drug is Cytokine Release Syndrome (CRS). The condition is associated with the use of monoclonal antibodies. Special precautions are taken to prevent this side effect – ask your doctor to explain the prevention method. Signs of the disorder include headaches, fever, breathing problems, upset stomach and vomiting.

Nerve disorders have appeared in some individuals when taking this drug. The side effects include fainting, seizures and speech problems. Age and health plays a role in the severity of the effects. If you are 65 years of age or older, care is needed when using this drug.

If you are pregnant or attempting to conceive, you should not take this drug. Talk with your doctor. The same rule applies to men. Take the extra precaution and use birth controls – avoid impregnating your partner during treatment. This drug can harm an unborn fetus. Your doctor can tell you when it's safe to conceive once treatment is complete.

You should also avoid breastfeeding – the data is unclear about the effect of the medication passing from mother to infant.

Storage

Because this treatment usually takes place in a hospital or at a health care facility, your medical team will take care of storing the drug correctly. If you are treated at home, follow the instructions from your doctor on proper storage and handling. Keep this drug out of the reach of children and pets.

Do not discard this container, supplies or drug in the trash. A health care facility, your pharmacist or doctor can help with disposal. After treatment, be sure to take all of your medical supplies and outdated medicines to one of the facilities for disposal.

Summary

Blinatumomab is an antibody used in the treatment of cancer, particularly ALL. It has numerous side effects that may cause discomfort, but its purpose of destroying cancerous antigens may mean these side effects are outweighed. Treatment is given over a four-week cycle, followed by a two-week rest. If you are pregnant or planning to become pregnant, you should not use this drug. Be sure you discuss the risks and the benefits of using this medicine with your doctor.

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Last Reviewed:
December 22, 2017
Last Updated:
April 04, 2018
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