title: A phase Ib/II trial of granulocyte-macrophage-colony stimulating factor and interleukin-2 for renal cell carcinoma patients with pulmonary metastases: a case of fatal central nervous system thrombosis.
abstract: BACKGROUND
  Interleukin-2 (IL-2) and granulocyte-macrophage-colony stimulating factor (GM-CSF) are cytokines with nonoverlapping pleiotropic effects. In a prior Phase Ib study, this combination of agents exhibited antitumor effects in the lungs of four of eight patients with renal cell carcinoma and pulmonary metastases. We conducted this Phase Ib/II trial to determine the response rate of renal cell carcinoma patients with pulmonary metastases treated with continuous infusion IL-2 plus GM-CSF.
  
  
  METHODS
  Patients with renal cell carcinoma and pulmonary metastases were treated with 1.5, 2.25, or 4.5 x 10(6) IU/m(2)/day 96-hour continuous infusion IL-2 on Days 1-4, 8-11, and 15-18, and 1.25, 2.25, or 2.5 microg/kg/day GM-CSF on Days 8-19.
  
  
  RESULTS
  Sixteen patients were treated per protocol, 14 of whom could be evaluated for disease progression. None of these 14 patients had >50% shrinkage of either total tumor burden or pulmonary metastasis. One patient developed Grade 5 neurotoxicity. Autopsy revealed acute multifocal cerebral venous thrombosis as well as acute subdural and subarachnoid hemorrhage.
  
  
  CONCLUSIONS
  The combination of IL-2 and GM-CSF may be associated with marked morbidity and, as in one case in this study, mortality. No significant antitumor activity was appreciated. Thus, the combination of IL-2 and GM-CSF, when administered at this dose and according to this schedule, does not appear to be active in renal cell carcinoma and is associated with significant toxicities. Further studies using this combination of agents should only be undertaken with extreme caution and particular attention to neurotoxicity.
authors.affiliation: Department of Medicine, University of Wisconsin, Madison, Wisconsin 53792, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Hotton
authors.forename: M
authors.initials: M
authors.lastname: Khorsand
authors.forename: J A
authors.initials: JA
authors.lastname: Hank
authors.forename: M
authors.initials: M
authors.lastname: Albertini
authors.forename: K M
authors.initials: KM
authors.lastname: Kim
authors.forename: G
authors.initials: G
authors.lastname: Wilding
authors.forename: M S
authors.initials: MS
authors.lastname: Salamat
authors.forename: M
authors.initials: M
authors.lastname: Larson
authors.forename: P
authors.initials: P
authors.lastname: Sondel
authors.forename: J H
authors.initials: JH
authors.lastname: Schiller
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000556:secondary*; D002543:Cerebral Hemorrhage / Q000139:chemically induced; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D017809:Fatal Outcome; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007376:Interleukin-2 / Q000008:administration & dosage* / Q000009:adverse effects; D020767:Intracranial Thrombosis / Q000139:chemically induced; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009420:Nervous System / Q000187:drug effects; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000139:chemically induced
chemical_list: D007376:Interleukin-2; D016178:Granulocyte-Macrophage Colony-Stimulating Factor