Toxicity management in patients receiving low-dose aldesleukin therapy

OBJECTIVE: To review the pathophysiology and subsequent treatment options f or low-dose aldesleukin-induced toxicity when administered via intravenous bolus infusion, continuous intravenous infusion, or subcutaneous injection. BACKGROUND: The adverse events associated with high-dose aldesleukin therap y (600 000 IU per kg iv every 8 h for a maximum of 14 doses) are well docum ented in the literature; however, the adverse event profile of lower doses and alternative administration routes are less well described. An understan ding of the adverse event profile associated with these alternative regimen s can enhance management of toxicity. DATA SOURCES: English-language clinical studies, abstracts, and review arti cles pertaining to low-dose intravenous, continuous intravenous infusion, o r subcutaneous injection of aldesleukin, as well as aldesleukin-induced adv erse events. STUDY SELECTION AND DATA EXTRACTION: Relevant studies were selected that as sist with understanding the pathophysiology, clinical management, diagnosis , and management of aldesleukin-induced adverse events. CONCLUSIONS: Aldesleukin therapy initiates a cytokine-mediated proinflammat ory process resulting in a toxicity profile that is different from traditio nal nonbiologic chemotherapeutic agents. The frequency and severity of adve rse events associated with aldesleukin administration are dependent upon do se, route, and administration schedule. In addition, most adverse reactions are self-limiting. Alleviation of aldesleukin-induced adverse effects can usually be achieved on an outpatient basis with agents such as antiemetics, antipyretics, and topical creams or lotions, as well as nonmedication inte rventions. Aggressive and proactive management of aldesleukin associated to xicities can help facilitate completion of therapy.