BETA - What is a monoclonal antibody and how is this drug class used to treat chronic lymphocytic leukemia?

What is a monoclonal antibody and how is this drug class used to treat chronic lymphocytic leukemia? Monoclonal antibody is a drug that has specific binding capacity to an antigen on the surface of a cell. For example, we have the antigen CD20 on the surface of B cells. So we have monoclonal antibodies that can bind. These are actually immune globulins, proteins that can bind to the anti-CD20. So we have two types of monoclonal antibodies that are approved for treatment of CLL. We have Rituximab and we have Obinutuzumab. Usually the way we use those for treating CLL is in combination. We use Obinutuzumab in combination with Venetoclax, for example, where it converts Venetoclax, which is a pill form of treatment, to a definite treatment, time-limited treatment, compared to an indefinite prolonged treatment. So we take the Obinutuzumab for six months, Venetoclax for one year, and the patients are done. The other use of, or it can also be combined with A-caliberutinib. We have data from the Elevate TN study, where there was one arm where A-caliberutinib was combined with Obinutuzumab. There are studies where we have Obinutuzumab as part of triplet therapy, where we use a Bcl2 inhibitor, Btk inhibitor, and an anti-CD20 monoclonal antibody. So this is one utility of anti-CD20 monoclonal antibodies for treatment of patients with CLL to get disease control. Now there's a specific complication of CLL called autoimmune complications. For example, we have autoimmune hemolytic anemia, or immune thrombocytopenic purpura, or ITP. That's where we use monoclonal antibodies also to control those diseases, and they have been found to be very effective. There are multiple options for treatment for patients with CLL. The most common option is a pill-based option, and that includes the Btk inhibitors and the Bcl2 inhibitors. And the second option is monoclonal antibodies. Now what's the difference between these two or three classes of drugs? The pills are essentially designed to go inside the cancer cell and turn the switch off, and the switch is the switch which keeps the cancer cells alive. So there are multiple switches in the cancer cells that can be turned off and the cancer dies, and those are the switches which get turned on to develop the cancer. So it's a very straightforward process. It seems straightforward, but it's way more complicated. But essentially, these pills are designed to target specific switches in the CLL cell. So Btk was the first major breakthrough. The most common one right now is the Btk inhibitors, which turn off Btk. The Bcl2 inhibitors flips off the Bcl2, and the cells die. So that's the most common thing. Now the monoclonal antibodies, on the other hand, is an IV drug that we use to treat patients. And the analogy that I use to explain it to you is that the Btk inhibitors are the most common inhibitors. So the Btk inhibitors are the most common inhibitors. And this is the Btk inhibitor. And this is the Bcl2 inhibitor. And this is the Btk inhibitor. And the Bcl2 inhibitor is a very good form of anti-cancer drug that we use to treat patients. And the analogy that I use to explain it to our patients is that if you had to kill bad guys in a neighborhood, you have two options. You can be smart about it, and you can kill them one by one with targeted bombing, so chemotherapy. Chemotherapy was that kind of an approach which worked for a lot of patients, but they obviously had a lot of side effects. But with chemotherapy, you dropped a bomb, killed the good guys, killed the bad guys, and hoped that the good guys will come back and the bad guys won't. And you did it again a month later. And you kept doing it for four or six times over four to six months until you got the cancer under good control. And obviously, all of the side effects that happen when you drop a bomb, the neighborhoods get damaged, the roads need to be repaired. All of that is what the patient has to go through in terms of side effects, nausea, vomiting, infections, and so on. So the end-monoclonal antibodies was very interesting because it finds the bad guys and kills only those and leaves the rest of the good guys around it alone. So that was the major advance. Now how do monoclonal antibodies do that? All bad guys have some sort of an antenna on their head which identifies them. We just have to find it. We have to find a way to identify the bad guys. And for multiple, for pretty much a lot of cancers, there's always some sort of a target, so to speak. So we find that target and then we develop these proteins, antibodies, very small proteins, which essentially can be given through the veins and they find the bad guys and kill it. And fortunately, they don't have a lot of collateral damage. And that's why they're well tolerated. The side effect profile is different. This do have their own side effects, but essentially the damage to the patients, the problems to the patients are much more manageable. The most common way of using these antibodies in CLL specifically has been to combine them with one of the other BTK inhibitors or BCL2 inhibitors. And that combination, turn the switch off, kill the bad guys, turn the switch off, kill the bad guys, that combination has actually proven to be the most effective. And that's why it's the most, one of the more commonly used treatments that we use for patients with CLL. The first one that we used was called Rituximab. There was Ofatumumab. We used to use, we still have access to it, but it's not used that much. And then more recently, we have Obinutuzumab that is being used mostly nowadays for patients with CLL.