Managing toxicities of high-dose interleukin-2.
Although high-dose interleukin-2 (IL-2, Proleukin), a highly toxic agent used in the treatment of renal cell carcinoma and melanoma, was initially associated with treatment-related mortality, it can, in the appropriate setting, be administered safely. High-dose IL-2 is associated with significant morbidity; however, the incidence and severity of toxicities have decreased as clinicians have gained experience with this agent and implemented toxicity prevention and management strategies. IL-2 toxicity can manifest in multiple organ systems, most significantly the heart, lungs, kidneys, and central nervous system. The most common manifestation of IL-2 toxicity is capillary leak syndrome, resulting in a hypovolemic state and fluid accumulation in the extravascular space. Capillary leak syndrome can contribute significantly to development of oliguria, ischemia, and confusion. Safe and effective administration of high-dose IL-2 consists of five key components: (1) administration by an experienced and knowledgeable health-care team, (2) adherence to strict patient-eligibility criteria, (3) implementation of standardized administration and patient assessment guidelines, (4) adherence to administration criteria, and (5) compliance with retreatment contraindications. This article reviews high-dose IL-2 toxicities and symptom management strategies and provides practical guidelines to facilitate the safe and effective administration of high-dose IL-2.
Schwartz
Rowena N
RN
Stover
Lori
L
Dutcher
Janice P
JP
D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy; D000075202:Contraindications; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007376:Interleukin-2 / Q000008:administration & dosage* / Q000009:adverse effects*; D007680:Kidney Neoplasms / Q000188:drug therapy; D008545:Melanoma / Q000188:drug therapy; D017410:Practice Guidelines as Topic
D000970:Antineoplastic Agents; D007376:Interleukin-2