Abstract
Interleukin-2 (IL-2) can provide long term durable remissions for patients with advanced or metastatic renal cell carcinoma. The perceived morbidity and the difficulties in delivering this treatment hampered its widespread use in these patients. This review aims to place IL-2 in the modern milieu by reviewing the pharmacology, efficacy and toxicity of this drug. These will be contrasted and compared with the new targeted-agents. The methodology of providing high dose IL-2 treatment, follow-up care and its impact on patient quality of life will be discussed. Importantly, the ability of these agents to provide durable, complete remissions for RCC patients will be placed in context. The goal is to provide the perspective and framework for the reader to balance the important attributes of each of these drugs during the clinical decision making process.
Highlights
Interleukin-2 (IL-2) is an important drug because it gives rise to durable complete remissions at a rate that is low (5%–10%) but seen consistently across multiple studies in patients with metastatic renal cell carcinoma
The advent of novel therapeutics engineered to directly target the molecules and receptors involved in tumor angiogenesis or signal transduction have completely changed the paradigm for treating advanced or metastatic renal cell carcinoma
The significant clinical benefit conferred by these new agents requires a reassessment of the place of immunotherapy in RCC patients
Summary
Interleukin-2 (IL-2) is an important drug because it gives rise to durable complete remissions at a rate that is low (5%–10%) but seen consistently across multiple studies in patients with metastatic renal cell carcinoma (mRCC). HD IL-2 received approval for treatment of mRCC based upon a compilation of data from seven phase II trials showing an objective response rate of 14%, with 5% and 9% being complete response (CR) and partial response (PR), respectively.[35] HD IL-2 administration is fraught with significant toxicity and has a high overall cost thereby limiting its general use.
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