Implementation of a High-Dose Interleukin-2 Immunostimulation Biotherapy Program

Abstract

Interleukin-2 (IL-2) is a cytokine that produces an in vivo immunostimulating effect when given systemically. This action may arise from stimulating the growth and expansion of cytotoxic T cells that in turn activate natural killer cells to attack tumors such as malignant melanoma and renal cell carcinoma. Therefore, administration of high-dose IL-2 can invoke an antitumor response in some patients. However, high-dose IL-2 induces severe and sometimes life-threatening toxicity, including vascular leak syndrome, hypotension, fever, and end-organ damage. Renal, hepatic, pulmonary, cardiac, and neurologic side effects have been described. Patients receiving IL-2 therefore require close monitoring to detect and treat life-threatening complications arising from treatment. The authors describe the steps taken to begin an IL-2 biotherapy program in a small ICU at a regional comprehensive cancer center. The addition of “elective” IL-2 admissions to the ICU has had a beneficial effect on stabilizing the daily census. In addition, it has brought a new cohort of patients who are highly appreciative of the care they receive and provides the nursing staff a new opportunity to develop expertise with cancer biotherapy.