Metastatic Melanoma Responsive To IL-2, Imiquimod Combo

Source: Clinical Oncology, September 2015

A combination therapy of intralesional interleukin (IL)-2 administered with topical imiquimod and a retinoid cream resulted in complete local response in 100% of 11 patients with metastatic melanoma, a small retrospective case study has revealed (J Am Acad Dermatol2015;73[4]:645-654, PMID: 26259990).

Clinicians at several tertiary and academic centers in the United States administered the drug combination in the 11 patients who had not responded to or experienced recurrence after treatments for the metastases. The previous treatments included surgical excision, radiation and drugs. On average, patients were 69 years of age at the time of treatment. Most had stage III melanoma caused by cutaneous in-transit metastases with or without a positive sentinel lymph node, and some had stage IV melanoma.

Patients received 3 to 7 million IU of aldesleukin initially, which was escalated to 15 to 22 million IU biweekly, and continued treatment for four to six weeks. All patients also received daily topical imiquimod and a retinoid cream, which was most commonly 0.1% tazarotene. The creams were applied to all tumors up to a 10-cm peripheral margin, when possible. Clinicians reduced topical treatment to five times per week once the treated sites became “intolerably” erythematous. When tolerated, patients received topical treatment for one week after completion of intralesional IL-2 therapy and for one week every month for one year.

According to the investigators, all patients had complete clinical response within one to three months of IL-2 initiation, with a two-year survival rate of 82%. Most treatment-related adverse events were mild to moderate; they included several cases of rigors that occurred within three to six hours of IL-2 injection and typically lasted for 15 to 30 minutes. There were isolated incidences of nausea, worsening of baseline depression, asymptomatic hypotension, local urticaria at treatment sites, and shortness of breath, and one patient required surgical debridement of necrotic tissue related to intralesional therapy.