High-Dose Interleukin-2 (HD IL-2) Therapy Should Be Considered for Treatment of Patients with Melanoma Brain Metastases

A retrospective review was performed on patients with stable melanoma brain metastases treated with HD IL-2 therapy (720,000？IU/kg per dose intravenously; 14 doses, 2 cycles per course, maximum 2 courses) from January 1999 to June 2011 at Saint Louis University. There were 5 men and 3 women; median age was 52.2 years (26.8–61.1 years). One patient started treatment with lung lesions only (after resection of melanoma brain disease) and experienced partial response. Seven patients had brain metastases at treatment initiation. Median overall survival (mOS) for entire cohort ( ) was 8.7 months (2.1 to 19.0 months). All patients with brain metastases at first dose ( ) showed progressive disease; mOS was 6.7 months (range 2.1–18.2 months) for this group. Patients received radiosurgery and whole brain radiation before and after HD IL-2 therapy. One patient had symptoms suggestive of neurotoxicity. A history of alcohol abuse was revealed during admission. The patient's symptoms improved with initiation of an alcohol withdrawal protocol. In this analysis, patients with melanoma brain metastases received HD IL-2 without treatment-related mortality. We think that HD IL-2 should be considered as a treatment option in patients with melanoma brain metastases who are otherwise eligible for therapy. 1. Introduction High-dose interleukin-2 (HD IL-2) therapy was FDA approved for the treatment of metastatic melanoma in 1998 [1]. Currently, it is the only FDA-approved regimen associated with continuous complete remission over long-term followup (>5 years) [2]. Despite the promise of cure, the overall response rate is grim, at 16% [3]. HD IL-2 therapy requires hospitalization with administration via central venous access and is associated with significant toxicities including capillary leak syndrome, cardiac tachyarrhythmias, and seizures. Because of these risks, its use has been restricted to a select group of patients with excellent performance status. Patients with melanoma brain metastases are usually considered to be ineligible for HD IL-2 therapy due to concerns of life-threatening cerebral edema and neurotoxicity. At our institution, patients with melanoma brain metastases, who were suitable candidates by all other criteria, were considered eligible for treatment. Our aim was to describe our institution’s experience of HD IL-2 therapy in melanoma patients with brain metastases. 2. Materials and Methods A retrospective chart review was performed on all melanoma patients with brain metastases treated with HD IL-2 therapy (720,000？IU/kg per dose intravenously; 14 doses,