15 Monoclonal Antibodies in Medicine— Today and Tomorrow

Abstract: Ever since Köhler and Milstein in 1975 discovered the technique of production of monoclonal antibodies (MoAb) in vitro, it has become all pervasive in every field of medicine and other scientific areas. Be it diagnostic, prognostic or therapeutic areas, MoAbs continue to play a central role and evolve. As immunology is the basis of our survival, MoAbs help us in diagnosing, prognosticating and managing certain malignancies, inflammatory conditions, autoimmune diseases and infectious diseases. Leukemias and lymphomas can not be diagnosed accurately without immunophenotyping. Development of new generation flow cytometer machines has helped in widening the field for diagnostics as well as measuring minimal residual disease (MRD) in hematological malignancies. In the therapeutic area, rituximab, a MoAb against CD20, has become an integral part of managing both low grade as well as high grade B cell non-Hodgkin’s lymphomas. Similar MoAbs against various CD antigens are being developed to treat other lymphomas and leukemias. In a number of solid tumors like breast cancer, advanced colon cancers and head and neck cancers, when combined with cytotxic chemotherapy, patients benefit significantly with agents like herceptin, bevacizumab, cetuximab, etc. In the field of autoimmune diseases like rheumatoid arthritis, bronchial asthma, multiple sclerosis, therapeutic MoAbs are being increasingly used. There appears to be a great potential of such agents in infectious diseases too; however, it is a relatively new area and much needs to be understood. Being biological agents, the MoAbs have their own profile of side effects like hypersensitivity, development of neutralizing antibodies, immunosuppressions leading to enhanced possibilities of opportunistic infections, etc. Of equal importance is exorbitant cost of these agents. Even in developed countries, the cost of them has become a burning issue. Therefore, judicious decisions should be taken in each case