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HD IL-2 should be considered for patients with melanoma brain metastases
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NEW YORK — Patients with melanoma who have brain metastases should not be considered ineligible for treatment with high-dose interleukin-2, according to study results presented at the HemOnc Today Melanoma and Cutaneous Malignancies meeting.
The FDA approved high-dose interleukin-2 (HD IL-2) in 1998 for treatment of metastatic melanoma.
Melinda B. Chu
“Traditionally, patients with brain metastasis have been thought to be ineligible for high-dose IL-2 treatment because of concerns about life-threatening cerebral edema and neurotoxicity,” Melinda B. Chu, MD, a dermatology resident at Saint Louis University, told HemOnc Today.
However, patients with melanoma brain metastases who were treated by John M. Richart, MD, at Saint Louis University Cancer Center demonstrated high performance status, met all other criteria and were deemed eligible for treatment with HD IL-2.
To evaluate outcomes among this patient population, Chu and colleagues performed a retrospective chart review on eight melanoma patients with stable brain disease — metastatic lesions that did not require steroids nor cause neurological deficits — who underwent treatment with HD IL-2 between 1999 and 2011.
Five of the patients were men. The median patient age was 52.2 years (range, 26.8 to 61.1 years). One patient started treatment with metastatic lung lesions after complete resection of a melanoma brain lesion. The other seven patients had brain metastases at the time of treatment initiation.
The treatment regimen, administered before and after radiosurgery or radiation, consisted of 720,000 IU/kg per dose IV for 14 doses, with two cycles per course for a maximum of two courses.
Prior studies showed median OS for patients with melanoma brain metastases is approximately 4 months. In this analysis, median OS for all patients was 8.7 months (range, 2.1 to 19 months).
All seven patients with brain metastases showed progressive disease. Median OS among those patients was 6.7 months (range, 2.1 to 18.2 months).
The patient who began HD IL-2 therapy with metastatic disease limited to the lungs underwent resection of the residual lung lesion and was deemed to show surgical complete response.
The researchers observed no treatment-related mortality, and no patients were transferred to the ICU, Chu said.
One patient developed symptoms suggestive of neurotoxicity. When researchers learned the patient had a history of alcohol abuse, she began an alcohol withdrawal protocol. The patient’s symptoms improved, allowing HD IL-2 treatment to continue.
“The findings suggest patients with stable brain metastases who are otherwise eligible for therapy should not be excluded from high-dose IL-2 treatment,” Chu said.
For more information:
Chu MB. Abstract #5. Presented at: HemOnc Today Melanoma and Cutaneous Malignancies; March 22-23, 2013; New York.
Disclosure: Chu reports no relevant financial disclosures.