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British Journal of Cancer (2014) 110, 14271432 | doi: 10.1038/bjc.2014.62
Keywords: melanoma; inhalation; pulmonary; interleukin-2; prophylaxis; treatment
Low-dose inhalation of interleukin-2 bio-chemotherapy for the treatment of pulmonary metastases in melanoma patients
C Posch*,1,2, F Weihsengruber1, K Bartsch1, V Feichtenschlager1, M Sanlorenzo2,3, I Vujic1, B Monshi1, S Ortiz-Urda2 and K Rappersberger1
1Department of Dermatology, The Rudolfstiftung Hospital, Academic Teaching Hospital, Medical University Vienna, Juchgasse 25, 1030 Vienna, Austria; 2Department of Dermatology, Mt Zion Cancer Research Center, University of California, 2340 Sutter Street N461, 94115 San Francisco, CA, USA and 3Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
Background: Interleukin-2 (IL-2) treatment for patients with metastatic melanoma has shown remarkable durable responses. Systemic administration of IL-2 may cause severe side effects, whereas local administration is considered to be a safe alternative. The lungs are common sites of metastases in melanoma patients causing considerable respiratory problems. We sought to evaluate the potential antitumoral effect of a low-dose inhalative IL-2 (lh-IL-2) regimen for patients with melanoma lung metastases. In addition, we explored the prophylactic potential of Ih-IL-2 after surgical removal of lung metastases in a study carried out in an outpatient setting.
Methods: Twenty patients with American Joint Committee on Cancer stage-IV (M1b and M1c) melanoma were enrolled in this study and treated with 3 3 million IU inhalative IL-2 q.d. together with monthly dacarbazine bolus injections. Five patients
received lh-IL-2 after surgical resection of lung metastases to prevent recurrence of the disease (prophylaxis group, N 5).
All other patients were enrolled in the treatment group (N 15). Clinical evaluations were carried out monthly and radiological
follow-up was performed every third month.
Results: Nine patients in the treatment group had a clinical benefit with partial regression (27%) or stable disease (33%). Four patients had progression of lung metastases (26.7%) and two patients were not evaluable (13.3%). In the prophylaxis group, none of the patients developed new lung metastases during lh-IL-2 therapy. The median follow-up period was 7.8 months in the treatment group and 25.7 months in the prophylaxis group. In the majority of patients, treatment was well tolerated.
Conclusions: Low-dose IL-2 inhalation might offer an effective and safe treatment option for lung metastases in melanoma patients. In addition, lh-IL-2 may have a prophylactic...