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Alva A, Daniels GA, Wong MKK, Kaufman HL, Morse MA, McDermott DF, Clark JI, Agarwala SS, Miletello G, Logan TF, Hauke RJ, Curti B, Kirkwood JM, Gonzalez R, Amin A, Fishman M, Agarwal N, Lowder JN, Hua H, Aung S, Dutcher JP. Contemporary experience with high-dose interleukin-2 therapy and impact on survival in patients with metastatic melanoma and metastatic renal cell carcinoma. Cancer Immunol Immunother 2016; 65:1533-1544. [PMID: 27714434 PMCID: PMC5099373 DOI: 10.1007/s00262-016-1910-x] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 09/29/2016] [Indexed: 01/13/2023]
Abstract
High-dose interleukin-2 (HD IL-2) was approved for treatment of metastatic renal cell carcinoma (mRCC) in 1992 and for metastatic melanoma (mM) in 1998, in an era predating targeted therapies and immune checkpoint inhibitors. The PROCLAIMSM registry was established to collect and analyze data for patients treated with HD IL-2 in the current era. This analysis includes 170 patients with mM and 192 patients with mRCC treated between 2005 and 2012 with survival data current as of July 27, 2015. For patients with mM, complete response (CR) was observed in 5 %, partial response (PR) in 10 %, stable disease (SD) in 22 %, and 63 % had progressive disease (PD). The median overall survival (mOS) for these patients was 19.6 months, with a median follow-up of 43.1 months. The mOS was not reached for patients achieving CR or PR, and was 33.4 months for patients with SD. For patients with mRCC, 6 % achieved CR, 9 % had PR, 22 % had SD, and 62 % had PD. The mOS was 41 months, with a median follow-up of 46.6 months. The mOS for patients who had CR and PR was not reached and was 49.6 months for patients with SD. There were no treatment-related deaths among 362 patients. The duration of mOS for patients with mM and mRCC is longer than historically reported. These data support a continued role for IL-2 in the treatment of eligible patients with mM or mRCC and warrant further evaluation of HD IL-2 in combination or sequence with other therapeutic agents.
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Affiliation(s)
- Ajjai Alva
- University of Michigan, Ann Arbor, MI, USA
| | - Gregory A Daniels
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Michael K K Wong
- University of Southern California, Los Angeles, CA, USA.,M.D. Anderson Cancer Center, Houston, TX, USA
| | - Howard L Kaufman
- Rutgers Cancer Center Institute of New Jersey, New Brunswick, NJ, USA
| | | | | | | | - Sanjiv S Agarwala
- St. Luke's University Health Network and Temple University, Bethlehem, PA, USA
| | | | | | | | - Brendan Curti
- Providence Portland Medical Center, Portland, OR, USA
| | - John M Kirkwood
- Hillman Cancer Center Research, University of Pittsburgh Cancer Institute, Pavillion L1 32c, Pittsburgh, PA, USA
| | - Rene Gonzalez
- University of Colorado Cancer Center, Aurora, CO, USA
| | - Asim Amin
- Levine Cancer Institute, Charlotte, NC, USA
| | | | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | - Hong Hua
- Prometheus Laboratories Inc., San Diego, CA, USA
| | - Sandra Aung
- Prometheus Laboratories Inc., San Diego, CA, USA.,Nektar Therapeutics, San Francisco, CA, USA
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Stenehjem DD, Toole M, Merriman J, Parikh K, Daignault S, Scarlett S, Esper P, Skinner K, Udager A, Tantravahi SK, Gill D, Straubhar AM, Agarwal AM, Grossmann KF, Samlowski WE, Redman B, Agarwal N, Alva A. Extension of overall survival beyond objective responses in patients with metastatic renal cell carcinoma treated with high-dose interleukin-2. Cancer Immunol Immunother 2016; 65:941-9. [PMID: 27277816 PMCID: PMC11028875 DOI: 10.1007/s00262-016-1854-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 05/30/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE In metastatic renal cell carcinoma (mRCC), survival benefit associated with objective response rates of 16-20 % with high-dose interleukin-2 (HDIL-2) is well established and discussed. Based on recently emerged data on efficacy of cancer immunotherapy, we hypothesized that the survival benefit with HDIL-2 extends beyond those achieving objective responses, i.e., to those who achieve stable disease as the best response to treatment. MATERIALS AND METHODS All sequential treatment naïve mRCC patients treated with HDIL-2 at the University of Utah (1988-2013) and University of Michigan (1997-2013) were included. Best responses on treatment were associated with survival outcomes using log-rank and COX regression with a landmark analysis at 2 months. RESULTS 391 patients (75 % male; median age 55 years) were included and belonged to the following prognostic risk categories: 20 % good, 64 % intermediate, and 15 % poor. Best responses on treatment were complete response (9 %), partial response (10 %), stable disease (32 %), progressive disease (42 %), and not evaluable for response (7 %). No significant differences in progression-free survival (HR 0.74, 95 % CI 0.48-1.1, p = 0.14) or overall survival (HR 0.66, 95 % CI 0.39-1.09, p = 0.11) were observed between patients achieving partial response versus stable disease. Significant differences in progression-free survival (HR 0.13, 95 % CI 0.09-0.22, p < 0.0001) and overall survival (HR 0.33, 95 % CI 0.23-0.48, p < 0.0001) were observed between patients achieving stable disease compared to those with progressive disease and who were not evaluable. CONCLUSIONS Survival benefit with HDIL-2 is achieved in ~50 % patients and extends beyond those achieving objective responses.
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Affiliation(s)
- David D Stenehjem
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Michael Toole
- University of Michigan, Ann Arbor, MI, USA
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joseph Merriman
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | | | | | - Peg Esper
- University of Michigan, Ann Arbor, MI, USA
| | | | | | | | - David Gill
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Alli M Straubhar
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Archana M Agarwal
- ARUP Laboratories, Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | | | | | | | - Neeraj Agarwal
- Division of Medical Oncology, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Ste 2123, Salt Lake City, UT, 84112, USA.
| | - Ajjai Alva
- Comprehensive Cancer Center, Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, 48109, USA.
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Abstract
This review provides updated information published in 2014 regarding advances and major achievements in genitourinary cancer. Sections include the best in prostate cancer, renal cancer, bladder cancer, and germ cell tumors. In the field of prostate cancer, data related to treatment approach of hormone-sensitive disease, castrate-resistant prostate cancer, mechanisms of resistance, new drugs, and molecular research are presented. In relation to renal cancer, relevant aspects in the treatment of advanced renal cell carcinoma, immunotherapy, and molecular research, including angiogenesis and von Hippel-Lindau gene, molecular biology of non-clear cell histologies, and epigenetics of clear renal cell cancer are described. New strategies in the management of muscle-invasive localized bladder cancer and metastatic disease are reported as well as salient findings of biomolecular research in urothelial cancer. Some approaches intended to improve outcomes in poor prognosis patients with metastatic germ cell cancer are also reported. Results of clinical trials in these areas are discussed.
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