Cytokines are proteins that activate the immune system in a general way. Two cytokines, interferon alpha and interleukin 2, can help boost immunity in patients with melanoma. Both drugs can help shrink metastatic (stage III and IV) melanoma in about 10% to 20% of patients. There are no studies that compare interleukin-2 (IL-2) to the current standard of care, dacarbazine (DTIC), or to placebo in the treatment of metastatic melanoma. IL2 can be given as low dose, intermediate dose of high dose. HIgh dose is probably the most effective but ti is also toxic.
After weighing and reviewing the evidence that does exist, the opinion of the Melanoma Disease Site Group is that high-dose IL-2 is a reasonable treatment option for a select group of patients with metastatic melanoma:
Patients should have a good performance status (Eastern Cooperative Oncology Group [ECOG] 0-1), and a normal lactate dehydrogenase (LDH) level.
Patients should have less than three organs involved or have cutaneous and/or subcutaneous metastases only and no evidence of central nervous system metastases. In this select group of patients IL-2 treatment can produce durable complete remissions.
The recommended dose and schedule of high-dose IL-2 is 600,000 IU/kg/dose intravenously over 15 minutes, every eight hours, for a maximum of 14 doses.
If high-dose IL-2 is delivered, the recommendation is that it be done in a tertiary care facility with staff trained in the provision of this treatment with appropriate monitoring. Low or intermediate dose IL2 is not recommended by the referenced guideline or by NCCN( MS-16).
However, ESMO mentions interleukin as an option without specifying a dose. On the other hand, a guideline by Petrella in 2007 alos does not recommend low dose interferon. It writes: “ Low-dose il-2 has consistently lower overall response rates (2%–5%) than does high-dose il-2, and hence low-dose treatment was not part of the recommendation.”
, MD et al, Single-agent interleukin-2 in the treatment of metastatic melanoma Curr Oncol. 2007 February; 14(1): 21–26.
Petrella T, Quirt I, Verma S, Haynes A, Charette M, Bak K, Melanoma Disease Site Group. Single-agent interleukin-2 in the treatment of metastatic melanoma: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2006 Mar 20. 32 p. (Evidence-based series; no. 8-5). [32 references]
NCCN.ORG, melanoma, 2012
R. Dummer et al, Melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up Ann Oncol (2010) 21 (suppl 5): v194-v197.