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Daily alternating administration of high‐dose alpha‐2b‐interferon and interleukin‐2 bolus infusion in metastatic renal cell cancer. A phase II study
Author(s) -
Bergmann Lothar,
Fenchel Klaus,
Weidmann Eckhart,
Enzinger HansMartin,
Jahn Bernhard,
Jonas Dieter,
Mitrou Paris S.
Publication year - 1993
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19930901)72:5<1733::aid-cncr2820720537>3.0.co;2-x
Subject(s) - medicine , alpha interferon , interferon alfa , bolus (digestion) , gastroenterology , progressive disease , chemotherapy , cancer , phases of clinical research , surgery , interferon , immunotherapy , immunology
Background . Both interleukin‐2 (IL‐2) and alpha‐interferon (α‐IFN) have some efficacy in renal cell cancer (RCC) as single agents. Additionally, there is some evidence for additive or synergistic antitumoral activity of IL‐2 and α‐IFN in vitro and possibly in vivo. Based on these data, the authors initiated a Phase II trial with a combination of recombinant IL‐2 (rIL‐2) and recombinant α‐IFN (α‐rIFN) in advanced RCC. Methods . Thirty‐six assessable patients with metastatic RCC were entered in this Phase II trial using a daily alternating schedule of α‐rIFN and rIL‐2. Over a period of 14 days, the patients received daily alternating treatment with 10 × 10 6 IU/m 2 of recombinant alpha‐2b‐interferon subcutaneously and 18 × 10 6 IU/m 2 of rIL‐2 as a 1‐hour intravenous infusion. This treatment schedule was repeated every sixth week up to a maximum of four cycles. After the second cycle, patients were examined for response. Patients with stable disease or better received two additional cycles of therapy. Patients with progressive disease were available for other strategies. Results . Thirty‐six patients entered the trial and were assessable for toxic effects. Thirty of 36 patients completed at least two cycles and were assessable for response. Nine patients achieved an objective response: 2 had complete responses (CR) and 7 had partial responses (PR). Three patients had a minor response. No effect was observed in patients with local relapse or bone metastases. A relapse‐free survival length of 6 months or longer was seen in both patients with CR (12, 23+ months) and in four of seven patients with PR (6, 7, 12, 12 months). The toxicity was moderate and included fever and nausea in most patients, and hypotension, fatigue, skin rash, and arthralgia in a minority of the patients. No Grade 4 and only occasionally Grade 3 toxicity was observed. Fluid retention was negligible. The monitoring of immunologic parameters showed a significant rebound lymphocytosis including cytotoxic (CD56+) cells; in responders the peak of lymphocytosis occurred up to 1 week later than in nonresponders. Peripheral lymphocytes obtained after therapy showed only a slight increase of natural killer cell and lymphokine‐activated killer cell activity. During therapy, there was a great release of secondary cytokines as tumor necrosis factor‐alpha, γ‐interferon, and interleukin‐6, with a peak level 2–4 hours after rIL‐2 infusion. Conclusions . In conclusion, daily alternating administration of α‐rIFN and rIL‐2 is effective in RCC with less toxicity, and the response rate is comparable to those of other immunotherapeutic schedules, including adoptive immunotherapy and combinations of high‐dose IL‐2 and α‐IFN.