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aldesleukin [IL-2] (Proleukin, Leukine)

Tradename: Proleukin. (recombinant IL-2) Indications: - metastatic renal cell carcinoma a) response rate 14% b) duration of response 20 months with some disease-free patients - cutaneous melanoma [3] - Kaposi's sarcoma - acute myeloid leukemia [3] Contraindications: 1) abnormal myocardial perfusion test 2) abnormal pulmonary function test 3) organ allograft 4) tachyarrhymthmias - sustained premature ventricular contractions (> 5) 5) uncontrolled cardiac arrhythmias 6) myocardial ischemia 7) intubation for > 72 hours 8) pericardial tamponade 9) renal dysfunction requiring dialysis for > 72 hours 10) coma or toxic psychosis lasting > 48 hours 11) repetitive or refractory seizures 12) ischmic bowel, bowel perforation 13) GI bleeding requiring surgery 14) brain metastasis [3] 15) status epilepticus 16] coma [3] 17] organ transplantation 18] lactation Warnings: 1) has been associated with capillary leak syndrome 2) intensive therapy is associated with impaired neutrophil function (reduced chemotaxis) a) increased risk of disseminated infection & endocarditis b) pre-existing infection should be treated prior to initiation of therapy 3) prophylactic antibiotics effective against S. aureus in patients with indwelling central catheters 4) aggressive treatment of suspected or documented infection Dosage: - 600,000 IU/kg IV every 8 hours for 14 doses, then repeat after 9 days Injectable: 22,000,000 IU/mL, 18,000,000 IU/mL when reconstituted Pharmacokinetics: Elimination: 13 minutes Adverse effects: 1) common (> 10%) - hypotension, dizziness, sensory dysfunction, sinus tachycardia, arrhythmias, pulmonary congestion, pruritus, erythema, dry skin, exfoliative dermatitis, rash, nausea/vomiting, fever/chills, pain, fatigue, weakness, malaise, edema, weight gain, diarrhea, stomatitis, anorexia, GI bleeding, anemia, thrombocytopenia, leukopenia, coagulation disorders, elevated liver function tests, elevated renal function tests hypomagnesemia, acidosis, hypocalcemia, hypophosphatemia, mental status changes, dyspnea, pulmonary edema, jaundice, oliguria, anuria, proteinuria 2) less common (1-10%) - bradycardia, premature ventricular contractions (PVCs), myocardial ischemia*, myocardial infarction*, cardiac arrest*, respiratory failure, tachypnea, wheezing, ascites, leukocytosis, eosinophilia, hypokalemia, hypoproteinemia, hyponatremia, alkalosis, hypocholesterolemia, dyspepsia, constipation, sensory disorders, syncope, hematuria, renal impairment, purpura, arthralgia, myalgia, weight loss, injection site reactions 3) uncommon (< 1%) - pancreatitis, hypothyroidism, coma, seizures, urinary frequency, alopecia, arthritis, muscle spasm, allergic reactions, congestive heart failure*, hypercalcemia 4) other - capillary leak syndrome (CLS) * heart failure from previous cardiomyopathy, myocarditis, or myocardial infarction occuring during treatment [2] Drug interactions: 1) corticosteroids may decrease toxicity of aldesleukin, but may decrease its effectiveness thus are not used in combination 2) agents that increase aldesleukin toxicity a) psychotropic drugs - narcotics, analgesics, antiemetics, sedatives, tranquilizers b) nephrotoxic agents - aminoglycosides, indomethacin c) myelotoxic agents - cytotoxic chemotherapeutic agents d) hepatotoxic agents - methotrexate, asparaginase 3) beta blockers & other hypotensive agents may potentiate hypotensive effects of aldesleukin

Related

capillary leak syndrome (CLS)

General

antineoplastic immunomodulator interleukin-2; IL-2; T-cell growth factor; TCGF (IL2)

References

  1. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 17. American College of Physicians, Philadelphia 1998, 2015
  3. Deprecated Reference
  4. Department of Veterans Affairs, VA National Formulary