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Comparison of acute toxicity and mortality after two different dosing regimens of high-dose interleukin-2 for patients with metastatic melanoma

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Abstract

We compared acute toxicity, drug exposure, in-hospital mortality, and inpatient length of stay between two currently recommended dosing protocols (from the National Comprehensive Cancer Network Guidelines) of high-dose interleukin-2 (IL-2) treatment for patients with metastatic melanoma. Patients with metastatic melanoma who received high-dose IL-2 treatment between 2003 and 2010 were identified. Chemotherapy orders, electronic medical records, paper medical charts, and patient discharge summaries were reviewed retrospectively. We identified 13 patients who had received 600,000 units/kilogram (kg)/dose and 15 patients who had received 720,000 units/kg/dose. Patients in the 720,000 units/kg/dose group had a higher rate of grade 3 and 4 bilirubin elevations (34 vs. 12 %), weight gain (any grade, 96 vs. 89 %), and thrombocytopenia (any grade, 75 vs. 65 %). Patients receiving the higher dose also experienced more dose-limiting neurotoxicity (45 vs. 23 %), large-volume diarrhea (15 vs. 0 %), and hepatotoxicity (7 vs. 0 %). There was no in-hospital mortality during treatment in either group. The average length of stay was similar between both groups (5 days, SD = 1 for both groups), and the median cumulative IL-2 exposure was similar between both groups for the first course (10.1 vs.10.5 million units/kg) and for all courses (approximately 11–12 million units/kg). Both high-dose IL-2 protocols had comparable in-hospital mortality and cumulative IL-2 exposure. The 720,000 units/kg/dose dosing scheme did not shorten the length of stay but did lead to greater acute toxicity. Therefore, as a result, we recommend 600,000 units/kg/dose when deciding between the two regimens.

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Conflict of interest

This research was not funded by any organization and the authors have no conflicts to disclose in regards to funding of this research. Additional potential conflict of interest information has been completed and submitted by each author and is attached in this submission.

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Authors and Affiliations

  1. Department of Pharmacy Services, University of Washington Medical Center/Seattle Cancer Care Alliance, 825 Eastlake Ave. East, Seattle, WA, 98109, USA

    Laura M. Alwan

  2. Department of Medicine, University of Utah Hospitals and Clinics, Salt Lake City, UT, USA

    Kenneth Grossmann & Neeraj Agarwal

  3. Department of Pharmacy Services, Huntsman Cancer Institute, University of Utah Hospitals and Clinics, Salt Lake City, UT, USA

    Daniel Sageser & Jeffrey A. Gilreath

  4. Department of Nursing, Huntsman Cancer Institute, Salt Lake City, UT, USA

    Joan Van Atta

Authors
  1. Laura M. Alwan
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  2. Kenneth Grossmann
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  3. Daniel Sageser
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  4. Joan Van Atta
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  5. Neeraj Agarwal
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  6. Jeffrey A. Gilreath
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Correspondence to Laura M. Alwan.

Additional information

Laura M. Alwan and Kenneth Grossmann contributed equally to this work.

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Alwan, L.M., Grossmann, K., Sageser, D. et al. Comparison of acute toxicity and mortality after two different dosing regimens of high-dose interleukin-2 for patients with metastatic melanoma. Targ Oncol 9, 63–71 (2014). https://doi.org/10.1007/s11523-013-0276-7

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  • DOI: https://doi.org/10.1007/s11523-013-0276-7

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