Roswell Park Cancer Institute offers interleukin 2 (IL-2) therapy for the treatment of advanced metastatic melanoma and for advanced metastatic kidney cancer. IL-2 therapy is a biological therapy and the only Food and Drug Adminstration (FDA) approved immunotherapy option for melanoma and kidney cancer. It works to boost the body’s immune system, helping the body fight the cancer.
The advantage to IL-2 therapy is that it is a specific treatment that targets the cancer. It is not a generic treatment such as chemotherapy that will affect all of the systems in the body. When IL-2 works, the cancer just melts away.
Current data suggests that for eligible patients, 10-15 percent may respond to the use of IL-2 therapy. Patients may receive up to five cycles of IL-2 therapy based on careful staging of their cancer and their initial response to IL-2 therapy.
The RPCI Multidisciplinary team runs one of the busiest IL-2 clinics in the United States. On average, the team manages more than 380 inpatient days per year with over 65 cycles of IL-2 treatment given.
For select patients, IL-2 can be nothing short of extraordinary
There are people who had extensive metastatic disease who are alive decades after IL-2 therapy. It can treat patients even with high tumor burden, completely eliminating the tumors from the patient’s body.
The likelihood of realizing either a complete or partial response to IL-2 hinges on two principal challenges:
- first, identifying patients who are most likely to achieve a response, and
- second, ensuring that the potent immunotherapy is delivered safely.
With one of the busiest IL-2 clinics in the United States—serving patients from several countries, including Canada—the RPCI team has developed a high level of expertise in selecting the best candidates and helping them manage IL-2’s significant side effects.
Studies show that IL-2 achieves a complete response in about 10% of patients who receive the treatment.
The tumor disappears completely and is invisible on physical examination, x-ray scan and CAT scan. Another 10% achieve partial response, in which evidence of cancer can still be found on physical exam or x-ray, but it’s smaller than it was before, and stable. A partial response is also very useful, because it can last for years. Because, at best, only one in five people will benefit from high-dose IL-2, it’s important to select them carefully.
Dramatic immune response
IL-2’s side effects can be hard on patients because the immune system is tricked into thinking that the patient has a severe, life-threatening infection. That’s not the case, but the consequence of tricking the body down this path is that it fires off the immune system in powerful ways. Consequently, patients experience significant problems with blood pressure, breathing, and cardiac function. Patients are screened very carefully before they come into the program, and they’re treated in only one specific place in this hospital. Candidates undergo a cardiac stress test, a pulmonary function test, and a scan to confirm that there’s no cancer in the brain. Patients are also screened for good kidney and liver function, as well as characteristics related to response that has been learned about through collective experience. The patient must be healthy enough so the immune system is strong enough to fight the cancer.
The treatment process
High-dose IL-2 immunotherapy is delivered only as an inpatient procedure. Patients are admitted on Monday, and most are discharged Saturday morning. They skip the following week, then return for a second week of treatment. Eight weeks after the second treatment, they return for scans to evaluate the response.
It’s important to keep in mind that, because IL-2 is an immunotherapy rather than chemotherapy, response is not immediate; it takes time for the immune system to “kick in—on average, a couple of months. That’s why we re-image them and re-study them for response about eight weeks after IL-2.
With some individuals, we’re unable to treat them, because the cancer is moving too quickly for IL-2 to help them. But IL-2 is not the only thing we can do for them; it’s always part of a larger plan.
Taking IL-2 to the next level
Because RPCI’s mission encompasses both patient care and research, RPCI clinicians are investigating why some patients don’t respond to IL-2 immunotherapy. A group of researchers are analyzing personal traits, blood and tumor samples of patients who do respond to high-dose IL-2 therapy for kidney cancer, to determine whether the new biomarker CA-IX is a predictor of positive outcome. A clinical research study is currently underway to answer that question, and a second IL-2 study, involving metastatic melanoma, is under review by RPCI’s Institutional Review Board.