In contrast to small molecules, biological response modifiers include biological agents that beneficially affect the patient's biological response to a neoplasm. Included are agents that mediate their antitumor effects indirectly (e.g., by enhancing the immunologic response to neoplastic cells) or directly on the tumor cells (e.g., differentiating agents). Recombinant proteins with potent effects on the function and growth of both normal and neoplastic cells that currently are in clinical trials include the interferons (see Chapters 49 and 52), interleukins (see Chapter 52), hematopoietic growth factors (see Chapter 53) such as erythropoietin, filgrastim (granulocyte colony-stimulating factor [G-CSF]), and sargramostim (granulocyte-macrophage colony-stimulating factor [GM-CSF]), tumor necrosis factor (TNF), and monoclonal antibodies such as trastuzumab, cetuximab, and rituximab. Among the agents now approved for clinical use in specific neoplastic diseases are interferon-a for use in hairy cell leukemia, condylomata acuminata, CML, and Kaposi's sarcoma associated with AIDS; interleukin-2 (IL-2) for kidney cancer; trastuzumab for breast cancer; and rituximab for B-cell lymphomas.
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