Bolus high dose interleukin-2 for the treatment of malignant melanoma

Background: High dose interleukin-2 therapy, administered in bolus, is cons idered to be a reasonable treatment option in a selected group of patients with metastatic malignant melanoma, Objectives: To present our experience using this mode of therapy in 21 pati ents with metastatic melanoma. Materials and Methods: The 21 patients in our study group comprised 13 men and 8 women with a mean age of 46 years (range 29-63). Their metastatic dis ease was present in all extracranial sites, dermal and sub-dermal metastase s being the most common (15 patients had at least one site, in addition to other locations of metastases), Patients with intracranial disease were exc luded due to the poor effectivity of IL-2 at this site. Treatment comprised a course of 2 weeks of therapy with a 1 week rest interval between. Radiol ogical and physical evaluation was performed 6-8 weeks after the first cour se. If a response was achieved a second course of therapy was given. Patien ts received up to 14 planned doses of IL-2 in each week, 720,000 IU/kg of I L-2 per dose i.v, in 15 minutes. Ail treatments were given in the surgical ward, and only one patient was hospitalized in the intensive care unit. Results: Of the 21 patients, one had a complete response that has lasted fo r 17 months and 5 patients had a partial response (range 3 months to 3 year s), One patient died during treatment, and one patient who refused further treatment because of no response died a few days after completion of treatm ent. Prior to therapy three of the responders had received autologous vacci nes with good immunological response (P=0.115), Toxic side effects were sig nificant, but they were treated successfully with no residual damage. Conclusions: High dose IL-2 can be administered safely in a surgical depart ment. The response rates achieved in this series justify the use of high do se IL-2 in a selected group of patients. To improve response rates, a combi nation of autologous vaccines prior to high dose IL-2 may be recommended.