Contemporary trends in high-dose interleukin-2 use for metastatic renal cell carcinoma in the United States.

Abstract

BACKGROUND:

Targeted therapies (TTs) have revolutionized metastatic renal cell carcinoma (mRCC) treatment in the past decade, largely replacing immunotherapy including high-dose interleukin-2 (HD IL-2) therapy. We evaluated trends in HD IL-2 use for mRCC in the TT era.

METHODS:

Our cohort comprised a weighted estimate of all patients undergoing HD IL-2 treatment for mRCC from 2004 to 2012 using the Premier Hospital Database. We assessed temporal trends in HD IL-2 use including patient, disease, and hospital characteristics stratified by era (pre-TT uptake: 2004-2006, uptake: 2007-2009, and post-TT uptake: 2010-2012) and fitted multivariable regression models to identify predictors of treatment toxicity and tolerability.

RESULTS:

An estimated 2,351 patients received HD IL-2 therapy for mRCC in the United States from 2004 to 2012. The use decreased from 2004 to 2008. HD IL-2 therapy became increasingly centralized in teaching hospitals (24% of treatments in 2004 and 89.5% in 2012). Most patients who received HD IL-2 therapy were men, white, younger than 60 years, had lung metastases, and were otherwise healthy. Vasopressors, intensive care unit admission, and hemodialysis were necessary in 53.4%, 33.0%, and 7.1%, respectively. Factors associated with toxicities in multivariable analyses included being unmarried, male sex, and multiple metastatic sites. African Americans and patients with single-site metastases were less likely to receive multiple treatment cycles.

CONCLUSIONS:

HD IL-2 therapy is used infrequently for mRCC in the United States, and its application has diminished with the uptake of TT. Patients are being increasingly treated in teaching hospitals, suggesting a centralization of care and possible barriers to access. A recent slight increase in HD IL-2 therapy use likely reflects recognition of the inability of TT to effect a complete response.

• Authors: Christopher B Allard, Francisco Gelpi-Hammerschmidt, Lauren C Harshman, Toni K Choueiri, Izak Faiena, Parth Modi, Benjamin I Chung, Ilker Tinay, Eric A Singer, Steven L Chang
• Journal: Urologic oncology (Urol Oncol) Vol. 33 Issue 11 Pg. 496.e11-6 (Nov 2015) ISSN: 1873-2496 [Electronic] United States
• PMID: 26210683 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Chemical References

• Antineoplastic Agents
• Interleukin-2

Topics

• Aged
• Antineoplastic Agents (therapeutic use)
• Carcinoma, Renal Cell (drug therapy, mortality, secondary)
• Cohort Studies
• Dose-Response Relationship, Drug
• Female
• Follow-Up Studies
• Humans
• Interleukin-2 (therapeutic use)
• Kidney Neoplasms (drug therapy, mortality, pathology)
• Male
• Middle Aged
• Neoplasm Metastasis
• Neoplasm Staging
• Prognosis
• United States