Progress report on the palliative therapy of 100 patients with neoplastic effusions by intracavitary low-dose interleukin-2

Our plain-English summary of Progress report on the palliative therapy of 100 patients with neoplastic effusions by intracavitary low-dose interleukin-2, by P. Lissoni, M. Mandalà, G. Curigliano, et al (Oncology, 2001).

The study

• Authors: P. Lissoni, M. Mandalà, G. Curigliano, G. Ferretti, C. Moro, A. Ardizzoia, F. Malugani, G. Tancini, E. Tisi, C. Arrigoni, S. Barni
• Journal: Oncology
• Published: 2001;60(4):308-12
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: Several cytokines, particularly IL-2 and interferons, are thought to be effective in the palliative therapy of neoplastic effusions. We report on the activity and toxicity of intracavitary administration of low-dose IL-2 in a case series of 100 cancer patients with neoplastic effusions.

Methods: One hundred patients with advanced solid tumors and neoplastic effusions underwent IL-2 intracavitary injection as first-line treatment. The most common sites of fluid accumulation were pleura (n = 68), peritoneum (n = 21) and pericardium (n = 11). Breast cancer, lung cancer and mesothelioma were the most frequent neoplasms in our series. One cycle consisted of intracavitary IL-2 at 6,000,000 IU on days 1 and 7.

Results: According to Paladine's criteria, an objective clinical response was achieved in 72% (complete response in 27% and partial response in 45%), with a median duration of 5 months (range: 1-11 months). The peritoneum was the least responsive site for neoplastic effusion reduction. IL-2 intracavitary injection was well tolerated in all patients; the only toxicity observed was fever >38 degrees C in 6% of the patients.

Conclusion: This study shows that intracavitary injection of IL-2 represents a feasible, well-tolerated and effective therapy of neoplastic fluid accumulation. Further studies are needed in order to compare the effectiveness of intracavitary IL-2 with other standard treatments.

Copyright 2001 S. Karger AG, Basel.

In plain English

This study described 100 patients with advanced solid tumors and cancer-related effusions (fluid build-up), treated in Monza, Italy, 1990 to 1995. Effusions were in the pleura (68), peritoneum (21) or pericardium (11). The commonest cancers were lung (27), breast (26) and mesothelioma (18). The article does not discuss asbestos. After drainage, each patient received low-dose interleukin-2 (IL-2) injected into the cavity: 6,000,000 IU twice, 7 days apart. Complete response occurred in 27 of 100 patients (95% confidence interval, or CI, 18.6 to 36.8%), partial response in 45 (95% CI 35 to 55.3%), and overall response in 72 of 100 (72%; 95% CI 62.1 to 80.5%). Response was statistically significantly lower for peritoneal (9/21) than for pleural or pericardial effusions (63/79). There was no significant difference in response by tumor type. Fever above 38 degrees C occurred in 6 of 100 patients; 32 of 100 (95% CI 23 to 42.1%) survived over one year. The authors concluded that this treatment was well tolerated and effective as palliative therapy. They noted their nonrandomized study could not compare IL-2 with other treatments.

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: Case series of consecutive patients (nonrandomized trial) treated with intracavitary IL-2; no comparison group
• Who was studied: 100 consecutive patients with advanced solid tumors and cytologically proven cancer-related pleural, peritoneal or pericardial effusion, admitted to San Gerardo Hospital of Monza, Italy, November 1990 to December 1995. There were 48 men and 52 women, median age 61 (range 40 to 90). Tumor types: lung cancer 27, breast cancer 26, mesothelioma 18, and others. Effusion sites: pleura 68, peritoneum 21, pericardium 11.
• Exposure: No asbestos or other environmental exposure was studied. The intervention was low-dose IL-2 injected into the drained cavity: two doses of 6,000,000 IU, 7 days apart (one cycle).
• Main results:
  • Complete response (no fluid re-accumulation for more than 30 days) in 27 of 100 patients (27%; 95% CI 18.6 to 36.8%), with a median duration of 7 months (range 2 to 11 months)
  • Partial response in 45 patients (45%; 95% CI 35 to 55.3%), with a median duration of 3 months (range 1 to 8 months)
  • Overall response in 72 of 100 patients (72%; 95% CI 62.1 to 80.5%), with a median duration of 5 months (range 1 to 11 months). In the other 28 patients, IL-2 failed to control fluid re-accumulation.
  • Complete response was more frequent in pericardial effusions than in pleural or peritoneal effusions (6/11 vs. 21/89), but the difference was not statistically significant (p = 0.07)
  • Response was statistically significantly lower in peritoneal effusions than in pleural or pericardial effusions (9/21 vs. 63/79; p less than 0.01)
  • No significant difference in response by tumor type, although the response was described as particularly high in pleural effusions caused by mesothelioma or breast cancer
  • After 3 months, the response persisted in 41 of 72 responding patients (57%; 95% CI 44.7 to 68.6%)
  • Side effects: no cardiovascular complications. Fever above 38 degrees C on the day of injection occurred in 6 of 100 patients. Grade 1 nausea occurred in 5 patients, all with peritoneal effusion.
  • 32 of 100 patients (32%; 95% CI 23 to 42.1%) survived longer than 1 year
• The authors' conclusion: The authors concluded that low-dose intracavitary IL-2 was a well-tolerated and effective palliative therapy for cancer-related effusions, regardless of tumor type and site, and was feasible in patients in poor clinical condition. They called for randomized studies comparing it with other intracavitary treatments.
• Limitations the authors state:
  • The study was nonrandomized, so IL-2 could not be compared with other intracavitary treatments
  • The optimal dose of intracavitary IL-2 has not been established
  • The response criteria used (Paladine's) are often hard to measure, and the benefit of a partial response depends on the patient's general condition

Topics

Medical terms in this study, explained in our Lexicon: Palliative Care, Cytokine, Pleura, Peritoneum, Pericardium, Lung Cancer, Mesothelioma, Neoplasm.

Related studies

• Palliative and therapeutic activity of IL-2 immunotherapy in unresectable malignant pleural mesothelioma with pleural effusion: Results of a phase II study on 31 consecutive patients — B. Castagneto, S. Zai, 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)
• The role of "closed abdomen" hyperthermic intraperitoneal chemotherapy (HIPEC) in the palliative treatment of neoplastic ascites from peritoneal carcinomatosis: report of a single-center experience — L. Orgiano, F. Pani, et al. (2016)
• Intrapleural recombinant IL-2 in passive immunotherapy for malignant pleural effusion — P. Astoul, J.R. Viallat, et al. (1993)
• A phase II study of combined intravenous and subcutaneous interleukin-2 in malignant pleural mesothelioma — C.W. Mulatero, R.T. Penson, et al. (2001)
• Subcutaneous seeding after ultrasound-guided placement of intrapleural catheter. An unusual complication of the intracavitary palliative treatment of pleural mesothelioma — S. Sartori, I. Nielsen, et al. (1999)

Browse more research in Oncology, or return to medical research.