Interleukin-2 in malignant pleural mesothelioma (and adenocarcinoma of the lung). The use of intrapleural and continuous intravenous infusions: preliminary results

Our plain-English summary of Interleukin-2 in malignant pleural mesothelioma (and adenocarcinoma of the lung). The use of intrapleural and continuous intravenous infusions: preliminary results, by N. Thatcher, P. Taylor, K.B. Carroll, et al (Cancer Treatment Reviews, 1989).

The study

• Authors: N. Thatcher, P. Taylor, K.B. Carroll, E.M. Loriaux, P. Palmer, C.R. Franks
• Journal: Cancer Treatment Reviews
• Published: 1989;16 Suppl A:161-2
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This preliminary report described a study of recombinant interleukin-2 (rIL-2) given into the pleural space and then intravenously to patients with malignant pleural effusions from mesothelioma or non-small cell lung cancer, at the Christie and Wythenshawe Hospitals in Manchester, UK. The authors noted that median survival in malignant pleural mesothelioma was only 6 months with systemic therapy. Eligible patients had histologically confirmed cancer unsuitable for radical surgery or radiotherapy, no prior systemic treatment, a Karnofsky performance status above 50 and a patent pleural space. Each course began with drainage of the effusion and an intrapleural infusion of rIL-2 at 3 x 10^6 U/m2. This was followed by continuous intravenous infusions at the same daily dose for 96 hours and, after 6 days' rest, for 108 hours. Courses were repeated at 21-day intervals. Four patients had been treated: three with mesothelioma and one with adenocarcinoma of the lung. All had progressive disease that had previously required repeated pleural drainage (median 4 procedures). Five complete courses were given. Toxicity was slight: there was fever in all courses, rashes in two, rigours and phlebitis in one each, eosinophilia in two, and one transient grade 1 rise in AST. All four patients had stable disease at last report. Three had no reaccumulation of fluid. The authors concluded that the regimen was very well tolerated but that it was too early to judge its effect on fluid reaccumulation or on the tumour.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This preliminary report from Manchester, UK, described treating malignant pleural effusion (fluid around the lung caused by cancer) with recombinant interleukin-2 (rIL-2), an immune-system protein. Four patients had been treated: three with malignant pleural mesothelioma and one with lung adenocarcinoma. All had progressing disease needing repeated draining. rIL-2 was given into the chest space through a drain, then by continuous infusion into a vein. Five complete courses were given. The authors reported very little toxicity: fever during all courses, peeling rashes during two, raised eosinophil counts (11 and 12%) during two, shivering during one, vein inflammation during one, and one mild, temporary rise in the liver enzyme AST. One patient's fluid returned and chemotherapy was given; that patient had stable disease 9 months after starting rIL-2. The adenocarcinoma patient needed radiotherapy to chest lymph nodes but had no fluid return for 6 months. The other two had just finished their first course, with stable disease. The authors concluded the treatment was very well tolerated but that it was too early to detect any convincing effect. Asbestos was not discussed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Preliminary report of an uncontrolled treatment study (small case series) of rIL-2 given into the pleural space and into a vein
• Who was studied: Four patients treated so far at Christie and Wythenshawe Hospitals, Manchester, UK: three with malignant mesothelioma and one with adenocarcinoma of the lung. All had progressive disease that had previously needed repeated pleural drainage (median 4 procedures). Dates of treatment are not given.
• Exposure: No asbestos exposure was studied. The treatment was recombinant interleukin-2 (rIL-2). It was infused through a chest drain over 1 hour, at a dose printed in the scan as '3 x lo6 U/m*' (apparently 3 x 10^6 units per square metre), in 300 ml of saline. A 96-hour continuous intravenous infusion at the same dose per day followed. After 6 days of rest, a further 108-hour infusion was given. Courses were repeated at 21-day intervals.
• Main results:
  • Across the four patients, a total of five complete courses were given
  • Very little toxicity was observed. There was no blood, kidney or liver toxicity, except a temporary grade 1 rise in AST during one course.
  • Peeling (desquamating) rashes occurred during two courses, and temporary rigours (shivering) during one course
  • Fever occurred throughout all courses during the rIL-2 infusions
  • Phlebitis (vein inflammation) occurred on one course and required a central line to be inserted
  • On two courses, eosinophilia (raised eosinophil white blood cells) of 11 and 12% was noted
  • One patient received two complete courses, but the fluid reaccumulated and chemotherapy was given. That patient had stable disease 9 months after starting rIL-2.
  • In the patient with adenocarcinoma, the effusion did not reaccumulate. That patient became more breathless and needed radiotherapy to mediastinal nodes, then had stable disease with no fluid reaccumulation for 6 months.
  • The two remaining patients had just completed their first course. Both had stable disease without reaccumulation of pleural fluid.
• The authors' conclusion: The authors concluded that intrapleural followed by intravenous rIL-2 was very well tolerated, but that it was too early to detect any convincing effect on fluid reaccumulation or other anti-tumour effects
• Limitations the authors state:
  • The authors state it was too early to detect any convincing effect on fluid reaccumulation or on the tumour

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Adenocarcinoma, Pleural Effusion, Mesothelioma, Non-Small Cell Lung Cancer, Median Survival, Systemic Therapy, Performance Status.

Related studies

• A phase II study of combined intravenous and subcutaneous interleukin-2 in malignant pleural mesothelioma — C.W. Mulatero, R.T. Penson, et al. (2001)
• Intrapleural interleukin-2 induces nitric oxide production in pleural effusions from malignant mesothelioma: a possible mechanism of interleukin-2-mediated cytotoxicity? — C. Porta, V. Rizzo, et al. (2002)
• Safety, feasibility and therapeutic activity of intrapleural autologous lymphocyte conditioned medium followed by systemic recombinant interleukin-2 and interferon-alpha in a patient with malignant pleural mesothelioma — S. Duensing, H. Hamm, et al. (1997)
• Intrapleural recombinant IL-2 in passive immunotherapy for malignant pleural effusion — P. Astoul, J.R. Viallat, et al. (1993)
• Phase I clinical and pharmacokinetic trial of the podophyllotoxin derivative NK611 administered as intravenous short infusion — I. Rassmann, R. Thödtmann, et al. (1998)
• Cytoreductive surgery and hyperthermic intrapleural chemotherapy for malignant pleural diseases: preliminary experience — M. Migliore, D. Calvo, et al. (2015)

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