An Overview of Biological Response Modifiers

Biological Response Modifiers (BRM) are drugs that are used in the treatment of bladder cancer, to decrease the rate and severity of serious infection due to chronic granulomatous disease which is an inherited immunodeficiency disorder, renal cell carcinoma, and being used in the treatment of hepatitis B and C and Kaposi’s sarcoma legally induced due to AIDS.

BRM, or immunotherapy, is a therapy that seeks to use the body’s immune system to fight cancer. Some of them are produced naturally in the body (endogenous) while others belong to the pharmaceutical products (exogenous) and some of the substances may increase the immune response while others decrease it.

BRMs are available as a powder for reconstitution in vial form with liquid and solution for subcutaneous and intramuscular use, intravenous and intralesional use.

BRMs work in the following ways:

• They are categorized under immunomodulatory drugs since they help to alter the immune response system to counter Actinic Pathology.
• They also come under ‘cytokines’ They are ‘recombinant proteins’ which incite the body to manufacture other chemicals that augment the body’s capacity to fight cancer.

How do Biological Response Modifiers Work?

Biological response modifiers (BRMs) are substances utilized in cancer treatment by altering or supplementing the body’s natural processes. Immunotherapy leverages BRMs to bolster the immune system’s activity, thereby enhancing the body’s inherent defenses against cancer.

The immune system comprises various types of white blood cells, each designated with specific functions. The immune response triggered by infected or damaged cells results from the interactions among different immune cell types. When an immune cell identifies a foreign or infected entity, a cascade of events is initiated, culminating in the elimination of the targeted entity. This activation is facilitated by proteins known as cytokines, which are produced by immune cells. Cytokines can influence not only the cell that secretes them but also other cells, playing a role in activating, modulating, and inhibiting immune responses.

The involvement of cytokines in the immune response renders them attractive candidates for cancer therapy. Typically, cytokines exist in minimal concentrations within the body. However, when utilized for cancer treatment, they are administered in significantly higher doses. The cytokines that are most commonly employed in cancer treatment include:

• Interleukin-2 (IL-2)
• Alpha Interferon (IFN).

Biological Response Modifiers: How Are They Used?

Biological response modifiers are utilized in the treatment of various medical conditions, including:

• Acute and chronic hepatitis C.
• Chronic hepatitis B.
• Chronic granulomatous disease is characterized by a malfunctioning immune system leading to a specific type of immunodeficiency.
• Malignant osteopetrosis is an inherited disorder affecting bone density.
• Metastatic renal cell carcinoma is a cancer originating in the kidney.
• Metastatic melanoma is a form of skin cancer that has spread.
• Carcinoma in situ of the urinary bladder, indicating localized cancer within the bladder.
• Papillary tumors are characterized by elongated, finger-like projections.
• Hairy cell leukemia is a rare malignancy of the blood and bone marrow that targets B lymphocytes.
• Follicular lymphoma is a cancer that involves lymphocytes, a type of white blood cell.
• Condylomata acuminata, which are anogenital warts caused by the human papillomavirus.
• AIDS-related Kaposi’s sarcoma is a cancer that arises from the cells lining lymphatic or blood vessels.

What Are the Side Effects of Biological Response Modifiers?

 The following are some frequently observed side effects:

• Nausea
• Vomiting
• Xerostomia (dry mouth)
• Altered taste perception
• Dorsal pain (back pain)
• Diarrhea
• Musculoskeletal pain (muscle or joint pain)
• Stomatitis (mouth sores)
• Abdominal discomfort
• Headaches
• Fatigue or weakness
• Decreased appetite
• Local reactions at the injection site, including pain, swelling, bleeding, redness, or irritation
• Dizziness
• Alopecia (hair loss)
• Exhaustion
• Sleep disturbances (insomnia)
• Chills, sore throat, fever, or cough
• Dermatological reactions such as rash, hives, or itching
• Edema (swelling) of the arms, hands, feet, ankles, or lower legs.

Names of Biological Response Modifiers

The biological response modifiers are identified by both generic and brand names, which include:

• Interleukin 2
• Intron A
• Nadofaragene firadenovec
• Proleukin
• Tice BCG
• Instilidrin (pending Food and Drug Administration approval)
• interferon alfa 2b
• Interferon alfa-2b
• interferon gamma 1b
• Actimmune
• Aldesleukin
• BCG intravesical live