Instructions for Participation in Online Activity
1. Read the following information below before beginning the online education article.
2. Study the online education article.
3. Complete the evaluation form and Post-Test
4. Upon successful completion of the online education article you will receive your
    Continuing Nursing Education certificate.
5. The evaluation form and Post-test must be completed by October 23, 2009, in order for you to receive
     your CNE certificate.



Overview and Purpose        
Antibody Dependent Cellular Cytotoxicity.  Antibody what you may say?  Antibody dependent cellular cytotoxicity, (ADCC) is a naturally occurring mechanism used by the immune system to destroy cells.  It is also one of the ways in which monoclonal antibodies, like rituximab (Rituxan), work to kill cancer. 

The question being asked is “Can cytokines enhance the mechanism of ADCC to make monoclonal antibodies work even better?”  Although monoclonal antibodies have increased response rates in non-Hodgkin’s Lymphoma (NHL), most patients treated will eventually experience progression of their disease.  So, clinicians are interested in exploring whether cytokines, particularly granulocyte macrophage colony stimulating factor (GM-CSF), can improve the efficacy of monoclonal antibody therapy by optimizing ADCC. 

Rituximab is being used as a model to see if this enhancement can be done with other monoclonal antibodies.  For example, alemtuzumab (Campath) used for chronic lymphocytic leukemia (CLL) works by similar mechanisms.  So if the ADCC mechanism of rituximab can be enhanced, there is a potential to improve therapy for a variety of diseases from hematologic malignancies to solid tumors.  To date, there are nine (9) monoclonal antibodies that are FDA approved for use in oncology and approximately 550 studies with monoclonal antibodies listed on www.clinicaltrials.gov.

The purpose of this educational activity is to explore research that suggests cytokines may enhance the mechanism of antibody dependent cellular cytotoxicity (ADCC) to make monoclonal antibodies (MoAbs) more effective.  This activity will enrich the nurse’s contribution to quality healthcare by stressing that research is needed to advance the development of new medications and treatment strategies so the nurse can serve not only as a patient advocate but also share with other oncology healthcare professionals, patients, and families.

About the Author   



Target Audience
This article is intended for oncology nurses and other healthcare professionals involved in the care of patients with cancer.    



Learning Objectives
The goal of this article is to introduce the concept of ADCC, the science behind the term, and application to oncology clinical practice. Specific educational objectives are:
1. Define the role of antibody dependent cellular cytotoxicity (ADCC) in the immune system.
2. Identify how the enhancement of rituximab is being used as a model to see if the same strategy
     can be accomplished with other monoclonal antibodies (MoAbs).
3. Identify three main mechanisms of action of monoclonal antibodies (MoAbs).
4. Recognize how the antibody structure relates to the function of the monoclonal antibodies (MoAb).
5. List the implications for nurses.    



Accreditation and Credit Designation
This continuing nursing education activity was approved by the Texas Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation.

This activity, CNE # O-AO-12599-10-07, meets Type I criteria for mandatory continuing education requirements toward relicensure as established by the Texas Board of Nursing.

In order to receive continuing nursing education credit for this educational activity, you must successfully complete a post-test (score of 70% or higher) and submit a completed evaluation form.     

Disclosure Policy This educational activity is supported by an educational grant from Bayer HealthCare Pharmaceuticals. The author presented has disclosed the following companies and the nature of the relationship below:   Employee or Consultant: Bayer HealthCare Pharmaceuticals, Merck, MGI PHARMA, Schering Plough, TopoTarget   Grant/Research Support: Amgen/ONS research award   Speaker's Bureau: EKR, MGI PHARMA   Major Stock or Investment Holder: None The content and/or presentation of the information Creative Cancer Concepts is providing with this educational offering will promote quality or improvements in healthcare and not a specific proprietary business interest of an entity producing healthcare goods or services consumed by, or used on patients. Creative Cancer Concepts is presenting research funded by a commercial company. The information presented will be based on generally accepted scientific principles and methods, and will not promote the commercial interest of the funding company. This CNE activity will include discussion of product use that is off label or considered investigational use.      Commercial Support Antibody "What" You Say? Antibody Dependent Cellular Cytotoxicity Enhancement is produced by Creative Cancer Concepts, Inc. An educational grant for this online educational tool was provided by Bayer HealthCare Pharmaceuticals .      Disclaimer The material in this program was compiled by Creative Cancer Concepts, Inc. with an educational grant from Bayer HealthCare Pharmaceuticals. This information should not be used by clinicians in the management of patients without evaluation of the patients' condition, possible contraindications, review of the manufacturer's product information, and consultation with recommendations of other authorities. Copyright ©2008 Creative Cancer Concepts, Inc. All rights reserved. Privacy Policy Creative Cancer Concepts, Inc. makes reasonable efforts to ensure that privacy issues are handled responsibly. CCC does not sell or share your information with other organizations that are not directly involved in this process. If you have further questions or concerns, you may contact us at: 972.772.4104 All rights reserved. No part of this publication may be translated, reproduced, stored, or transmitted by any means or in any type of media form including electronic, mechanical, photocopying, recording, broadcasting, or otherwise without prior permission from the publisher. © 2008 by Creative Cancer Concepts, Inc. No material may be reproduced in whole or in part, in any form, without written permission from the publisher.

All correspondence should be directed to:

Editor, Antibody "What" You Say?
Antibody Dependent Cellular Cytotoxicity Enhancement
Creative Cancer Concepts, Inc.
705 N. Goliad St.
Rockwall, TX 75087
Phone: 972.772.4104
Fax: 972.722.8323
Email: c3administrator@creativecancerconcepts.com