Researchers are suggesting that high-dose interleukin-2 (HD IL-2) therapy should be considered as a treatment option in patients with melanoma brain metastases who are otherwise eligible for therapy, based on the encouraging results of a small retrospective review.
Five men and three women (median age 52.2 years; range 26.8–61.1 years) with stable melanoma brain metastases underwent HD IL-2 therapy between January 1999 and June 2011 at Saint Louis University (SLU) in St. Louis, Missouri. The regimen consisted of 14 doses at 720,000 IU/kg per dose intravenously, two cycles per course, for a maximum of two courses. Three patients had radiosurgery, and one patient had whole-brain radiation prior to HD IL-2 therapy. After HD IL-2 therapy, five patients received consolidation whole-brain radiation, and four underwent radiosurgery.
As noted in an SLU statement accompanying the release of the study results in Chemotherapy Research and Practice, median overall survival of patients with melanoma brain metastases is normally approximately 4 months. But the investigative team, led by SLU’s John Richart, MD, found that the median overall survival for the entire HD IL-2 cohort was 8.7 months (range 2.1–19 months).
All seven patients with brain metastases at first dose showed progressive disease; median overall survival for this group was 6.7 months (range 2.1–18.2 months). The eighth patient, who began HD IL-2 therapy with metastatic disease limited to the lungs after complete radiosurgical response of a solitary brain lesion prior to HD IL-2 treatment, experienced a marked partial response to HD IL-2. After this therapy, the patient underwent resection of residual lung lesions and was deemed to show complete response in this analysis.
One patient with a history of alcohol abuse had symptoms suggestive of neurotoxicity; those symptoms improved upon initiation of alcohol-withdrawal protocol. No treatment-related deaths occurred.
“Traditionally, melanoma patients with brain metastases have not been considered for HD IL-2 because treatment was thought to be futile,” explained Richart in the SLU statement. “Our study shows that having this condition does not exclude a patient from getting this treatment and can in fact improve the length of their life.”