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High-dose interleukin 2 in patients with metastatic renal cell carcinoma with sarcomatoid features.

Abstract High-dose interleukin-2 (HD IL-2) is used in the treatment of metastatic renal cell carcinoma (mRCC) and has an overall response rate (ORR) of 12-20% and a complete response rate (CR) of 8% in unselected populations with predominantly clear cell type renal cell carcinoma. Nearly 10-15% of patients with renal cell carcinoma exhibit sarcomatoid differentiation, a feature which correlates with a median overall survival (OS) of 9 months and overall poor prognosis. We report a single institution experience with 21 patients with mRCC with sarcomatoid features post-nephrectomy who were treated with HD IL-2.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title plos one
Publication Year Start




PMID- 29261796
OWN - NLM
STAT- MEDLINE
DCOM- 20180108
LR  - 20180108
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 12
IP  - 12
DP  - 2017
TI  - High-dose interleukin 2 in patients with metastatic renal cell carcinoma with
      sarcomatoid features.
PG  - e0190084
LID - 10.1371/journal.pone.0190084 [doi]
AB  - BACKGROUND: High-dose interleukin-2 (HD IL-2) is used in the treatment of
      metastatic renal cell carcinoma (mRCC) and has an overall response rate (ORR) of 
      12-20% and a complete response rate (CR) of 8% in unselected populations with
      predominantly clear cell type renal cell carcinoma. Nearly 10-15% of patients
      with renal cell carcinoma exhibit sarcomatoid differentiation, a feature which
      correlates with a median overall survival (OS) of 9 months and overall poor
      prognosis. We report a single institution experience with 21 patients with mRCC
      with sarcomatoid features post-nephrectomy who were treated with HD IL-2.
      METHODS: Twenty one patients with mRCC with sarcomatoid features post-nephrectomy
      who underwent therapy with HD IL-2 were identified at the University of
      Pittsburgh Medical Center from 2004 to 2016. Baseline patient characteristics, HD
      IL-2 cycles, time to progression, and subsequent therapies were evaluated. OS and
      progression-free survival (PFS) in the cohort were calculated using the
      Kaplan-Meier method. Disease characteristics were evaluated for significance
      using the Fischer's exact test and Wilcoxon rank sum test. RESULTS: Patients were
      predominantly Caucasian males with a median age of 54 years. A majority, 86% of
      these patients, had metastatic disease at time of initial presentation, primarily
      with lung and lymph node involvement. The ORR and CR with HD IL-2 was 10% and 5%,
      respectively. Initial localized disease presentation is the only variable that
      was significantly associated with response to HD IL-2 (p = 0.0158). Number of HD 
      IL-2 doses did not correlate with response with a mean of 16.5 and 15.0 total
      doses in responders and non-responders, respectively (p = 0.53). Median PFS with 
      HD IL-2 was 7.9 months (95% CI, 5.0-21.3). Median OS was 30.5 months (95% CI
      13.3-57.66). Within the subset of patients who had progression on IL-2, median OS
      was 19.4 months (95% CI, 13.3-35.3). In patients who received second-line
      therapy, median PFS was 7.9 months (95% CI 2.4-10.2). CONCLUSION: In patients
      with mRCC with sarcomatoid features, use of HD IL-2 was associated with a modest 
      ORR and a higher survival compared to historical controls (patients with mRCC and
      sarcomatoid features). Thus, HD IL-2 may have a role in treating selected
      patients with mRCC with sarcomatoid features.
FAU - Achkar, Tala
AU  - Achkar T
AUID- ORCID: http://orcid.org/0000-0002-1370-3392
AD  - University of Pittsburgh, Department of Medicine, Division of
      Hematology/Oncology, Pittsburgh, Pennsylvania, United States of America.
FAU - Arjunan, Ananth
AU  - Arjunan A
AD  - University of Pittsburgh, Department of Medicine, Division of
      Hematology/Oncology, Pittsburgh, Pennsylvania, United States of America.
FAU - Wang, Hong
AU  - Wang H
AD  - University of Pittsburgh, Department of Public Health, Biostatistics, Pittsburgh,
      Pennsylvania, United States of America.
FAU - Saul, Melissa
AU  - Saul M
AD  - University of Pittsburgh, Department of Health Information Management,
      Pittsburgh, Pennsylvania, United States of America.
FAU - Davar, Diwakar
AU  - Davar D
AD  - University of Pittsburgh, Department of Medicine, Division of
      Hematology/Oncology, Pittsburgh, Pennsylvania, United States of America.
FAU - Appleman, Leonard J
AU  - Appleman LJ
AD  - University of Pittsburgh, Department of Medicine, Division of
      Hematology/Oncology, Pittsburgh, Pennsylvania, United States of America.
FAU - Friedland, David
AU  - Friedland D
AD  - University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh,
      Pennsylvania, United States of America.
FAU - Parikh, Rahul A
AU  - Parikh RA
AD  - University of Kansas Medical Center, Westwood, Kansas, United States of America.
LA  - eng
PT  - Journal Article
DEP - 20171220
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Interleukin-2)
SB  - IM
MH  - Carcinoma, Renal Cell/*secondary
MH  - Clinical Trials as Topic
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Humans
MH  - Interleukin-2/pharmacology/*therapeutic use
MH  - Kaplan-Meier Estimate
MH  - Kidney Neoplasms/*secondary
MH  - Male
MH  - Middle Aged
MH  - Sarcoma/*pathology
PMC - PMC5738119
EDAT- 2017/12/21 06:00
MHDA- 2018/01/09 06:00
CRDT- 2017/12/21 06:00
PHST- 2017/09/12 00:00 [received]
PHST- 2017/12/07 00:00 [accepted]
PHST- 2017/12/21 06:00 [entrez]
PHST- 2017/12/21 06:00 [pubmed]
PHST- 2018/01/09 06:00 [medline]
AID - 10.1371/journal.pone.0190084 [doi]
AID - PONE-D-17-32518 [pii]
PST - epublish
SO  - PLoS One. 2017 Dec 20;12(12):e0190084. doi: 10.1371/journal.pone.0190084.
      eCollection 2017.