Monoclonal Antibodies Consent 🧬

Consent guide for monoclonal antibody treatment: explanation, common risks, alternatives, monitoring, and drug-specific counselling points.

📌 Procedure

Monoclonal antibodies are targeted treatments used in cancer, autoimmune, inflammatory, and allergy conditions.
Choice of agent depends on diagnosis, prior treatment response, and safety profile.

How treatment is given (day unit infusion or injection schedule).
Expected benefits and realistic goals of therapy.
Monitoring plan: blood tests, infection screening, and review appointments.
Need to report red-flag symptoms early (fever, breathlessness, chest pain, severe rash, reduced urine output).

Infusion/injection reactions: flushing, rash, dyspnoea, hypotension, fever, and chills (often highest risk during early doses).
Serious infections can occur, including TB, bacterial sepsis, and opportunistic fungal/viral infections depending on agent.
Viral reactivation risk (especially hepatitis B with B-cell depleting therapies).
Organ-specific toxicity depending on agent (cardiac, pulmonary, hepatic, endocrine, neurological, renal, and GI).
Allergic/anaphylactic reactions (rare but potentially life-threatening; can occur even after prior tolerated doses).
Potential fetal risk: contraception and pregnancy counselling may be required for selected agents.

Baseline bloods as relevant to agent: FBC, renal profile, liver profile, CRP/ESR, and lipids where indicated.
Infection screening before selected agents: TB and hepatitis B/C (plus HIV where locally indicated).
Baseline cardiac assessment (e.g. echocardiography) for HER2-targeted therapy such as trastuzumab.
Review vaccination status and avoid live vaccines during/after treatment windows where contraindicated.
Document current infection symptoms and defer treatment if clinically unsafe.

Rituximab: important risks include severe infusion reactions, hepatitis B reactivation, and rare PML; monitor for delayed cytopenias/infection.
Infliximab / Adalimumab (TNF inhibitors): serious infection risk (TB, fungal, sepsis), possible hepatitis reactivation, caution in demyelination and heart failure.
Trastuzumab: risk of cardiomyopathy/LVEF reduction; baseline and interval cardiac monitoring are essential.
Pembrolizumab / Nivolumab: immune-related toxicity can involve lungs (pneumonitis), bowel (colitis), liver (hepatitis), kidneys (nephritis), endocrine organs, skin, and rarely heart/neurological systems.
Tocilizumab: serious infection risk, transaminitis/hepatotoxicity, neutropenia/thrombocytopenia, lipid elevation, and rare GI perforation.
Omalizumab: anaphylaxis warning; early-dose post-injection observation and clear emergency advice are required.

How long will I need this? - Duration depends on indication and response.
Will I lose my hair? - Usually less common than with traditional chemotherapy, but adverse effects vary by drug.
Can I get vaccines? - Some live vaccines may be unsuitable; discuss vaccine timing with your specialist team.
What if I feel unwell after treatment? - Seek urgent medical advice for fever, breathing problems, chest pain, severe diarrhoea, jaundice, confusion, reduced urine output, or severe rash.