Phase 1 Clinical Trial of Recombinant Interleukin-2: A Comparison of Bolus and Continuous Intravenous Infusion

Abstract

The toxicologic, biologic, and clinical effects of recombinant interleukin-2 (IL-2) were tested in 25 patients with cancer. Escalating doses from 10³ to 10⁷ U/m² per day were given by either daily bolus injection (BI) or continuous infusion (CI) for 7 consecutive days. Dose-limiting toxicities included a decline in performance status, systolic hypotension, and fever, which reversed promptly with discontinuation of therapy. The maximum tolerated dose of IL-2 by BI for 7 days was 3 X 10⁶ U/m² per day and for CI was 10⁶ U/m² per day. Significant changes in the number, phenotype, and function of circulating peripheral blood lymphocytes occurred at doses > 10⁶ U/m² per day by both administration schedules. With the initiation of therapy, a decline in the number of circulating peripheral blood lymphocytes (PBL) was seen in patients treated by either BI or CI. Additionally, the in vitro cytotoxic activity of these PBL against K562 was markedly decreased. Within 24 h of completing BI or CI, a rebound increase in the number of circulating PBL was seen. The phenotype of the circulating PBL after completion of treatment showed a significant (p > 0.05) increase in the numbers of OKT-3+, OKT-8+, OKT-10+, OK-Ia+, OKMI +, and OKT-11 + for patients treated by CI. Those patients treated by BI had a significant increase in Ia+ and OKT-10+ cells. At IL-2 doses >10⁵ U/m² per day, the PBL obtained following treatment with rIL-2 demonstrated in vitro cytotoxic capacity against K562 target cells that was significantly enhanced over pretreatment levels. This study demonstrates that IL-2 can be given by CI or BI in a non-ICU setting with acceptable dose-dependent toxicity. Upon completion of treatment an increase in the number of activated cells could be detected. Although no clinical responses occurred, the generation of endogenous activated PBL capable of enhanced cytotoxicity is encouraging. Future studies will explore the use of multiple courses of treatment with IL-2 to determine if therapeutic efficacy can be accomplished.