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Annals of Surgical Oncology

, Volume 12, Issue 5, pp 381–390 | Cite as

Initial Clinical Response Predicts Outcome and Is Associated With Dose Schedule in Metastatic Melanoma and Renal Cell Carcinoma Patients Treated With High-Dose Interleukin 2

  • Kathryn Spanknebel
  • Kenneth Y. Cheung
  • John Stoutenburg
  • Karl Hurst-Wicker
  • Charles Hesdorffer
  • Gail DeRaffele RN
  • and Howard L. Kaufman
Article

Abstract

Background

High-dose interleukin (IL)-2 is an effective agent for the treatment of metastatic malignant melanoma and renal cell carcinoma. This study evaluated the outcomes of patients receiving two commonly used intravenous IL-2 schedules that have never been directly compared.

Methods

Forty-seven metastatic malignant melanoma and renal cell carcinoma patients were identified from a prospective database who underwent high-dose IL-2 therapy (720,000 or 600,000 IU/kg) during 1999 to 2003. Disease-specific survival (DSS) was calculated by the Kaplan-Meier method with the log-rank test on an intention-to-treat basis. Multivariate Cox regression analysis of prognostic variables associated with outcome was performed. Factors associated with initial response and prevention of disease progression were determined.

Results

Objective response (5 partial and 5 mixed) or disease stabilization was noted in 9 (20%) and 10 (22%), respectively, of 46 assessable patients after 1 course of therapy. Four patients (22%) achieved disease-free status after the third course of IL-2 (n = 1) or surgical resection of confined metastatic disease (n = 3). At 19.1 months’ median follow-up, factors associated with improved DSS included an initial clinical response to IL-2 therapy (P < .001) and a higher administered dose (P = .04). Patients who received 720,000 IU/kg were more likely to experience an initial major objective response (P = .03) and disease stabilization (P = 0.03) independent of the tumor treated. Objective response early in the course of therapy was the only independent predictor of tumor-related mortality (P = .004).

Conclusions

The initial clinical response to IL-2 therapy is an independent predictor of improved outcome associated with DSS and the 720,000 IU/kg dose. These results support further prospective trials with increased IL-2 dose schedules in a larger cohort of patients.

Keywords

Melanoma Renal cell carcinoma Immunotherapy Interleukin 2 Metastatic. 

Notes

Acknowledgments

Supported by grants from the National Institutes of Health (K08–79881), the National Cancer Institute (R01-093696), and the Doris Duke Charitable Foundation (T98052).

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Copyright information

© The Society of Surgical Oncology, Inc. 2005

Authors and Affiliations

  • Kathryn Spanknebel
    • 1
  • Kenneth Y. Cheung
    • 2
  • John Stoutenburg
    • 3
  • Karl Hurst-Wicker
    • 1
  • Charles Hesdorffer
    • 1
    • 3
  • Gail DeRaffele RN
    • 1
  • and Howard L. Kaufman
    • 1
  1. 1.Department of SurgeryColumbia University College of Physicians and SurgeonsNew York
  2. 2.Department of BiostatisticsColumbia University Mailman School of Public HealthNew York
  3. 3.Department of Medicine, Division of Hematology and OncologyColumbia University College of Physicians and SurgeonsNew York

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