Sketchy Pharm: Rituximab, Cetuximab, Bevacizumab, Alemtuzumab, Trastuzumab

Question 1

What kind of antibody is rituximab?

Answer 1

Chimeric

(You know this from the -ximab suffix, but Sketchy also has the guy in the coronation RITUal having a chimera on his cloak.)

Question 2

What surface receptor does rituximab bind?

Answer 2

CD20

(This is symbolized by the archers next to the RITUal –archers being Sketchy’s symbol for B cells –and they have two X’s on their tunics to help you remember 20.)

Question 3

For what diseases is rituximab used?

Answer 3

• T-cell and B-cell malignancies (represented by the quilt with the archers and knights)
• Autoimmune disorders caused or aggravated by B cells (like the RA lamps above the ritual)

Question 4

What are side effects of rituximab?

Answer 4

• Immunosuppression with repeated use (pope with cane)
• PML (guy with white laurels)
• Pruritus, swelling, headache, and fever soon after IV administration (swollen cherub with red skin swinging on ivy)
• Serum sickness one week after use (coronated guy with red skin; the murderer made the poison slow-onset to get away)

Question 5

How can the IV reactions to rituximab be treated?

Answer 5

NSAIDs and antihistamines

Question 6

Serum sickness is treatable with ______________.

Answer 6

steroids

Question 7

What receptor does cetuximab target?

Answer 7

EGFR

(This symbol is a little obtuse: the elephant’s TUsks should remind you of ceTUximab, and the elephant’s saddle has GiRaFfEs on it.)

Question 8

What cancers can be treated with cetuximab?

Answer 8

Colorectal cancer and squamous cell carcinoma

These make sense because they’re both epithelial cancers.

Question 9

Just to help tie things together, what small molecule inhibitor targets the same pathway as cetuximab?

Answer 9

Erlotinib (remember GEoFfRey –the EaRL Of TINIB?)

Question 10

What are side effects of cetuximab?

Answer 10

• Pruritus, swelling, headache, and fever soon after IV administration (swollen cherub with red skin swinging on ivy)
• Acneiform rash (like the red spots on the giraffes –also the same effect as erlotinib)
• Serum sickness (the elephant also drank the poisoned chalice)

Question 11

Bevacizumab targets _____________.

Answer 11

VEGF (like the BEVerage lady poisoning the red punch next to chopped VEGetables)

Question 12

What diseases are treatable with bevacizumab?

Answer 12

• Metastatic cancers

* Wet macular degeneration (like the retina platter that the waitress is bringing the poisoned punch on)

Question 13

What are side effects of bevacizumb?

Answer 13

• Bleeding (like the punch spilled on the servants’ aprons) –because of this, bevacizumab is contraindicated in those who’ve recently had surgery
• Thromboembolic events (like the thrombus floating in the poisoned punch)
• Intestinal perforation (like the haustra-shaped vegetable bag that split open on the floor beneath the table)
• Pruritus, swelling, headache, and fever soon after IV administration (swollen cherub with red skin swinging on ivy)

Question 14

Alemtuzumab targets ____________.

Answer 14

the CD52 receptor on T cells and B cells (like the guy begging for ALMs from the archer and knight)

Question 15

What does trastuzumab target?

Answer 15

The HER2/neu tyrosine kinase

Think of the woman working on the TrASTuzumab TApeSTry with HER 2 NEWborns.

Question 16

What side effects are associated with trastuzumab?

Answer 16

• Slight decrease in LVEF (like the torn heart design in the tapestry)
• Pruritus, swelling, headache, and fever soon after IV administration (swollen cherub with red skin swinging on ivy)