Schwartz Rowena N, Stover Lori, Dutcher Janice P
Oncology (Williston Park). 2002 Nov;16(11 Suppl 13):11-20.
Although high-dose interleukin-2 (IL-2, Proleukin), a highly toxic agent used in the treatment of renal cell carcinoma and melanoma, was initially associated with treatment-related mortality, it can, in the appropriate setting, be administered safely. High-dose IL-2 is associated with significant morbidity; however, the incidence and severity of toxicities have decreased as clinicians have gained experience with this agent and implemented toxicity prevention and management strategies. IL-2 toxicity can manifest in multiple organ systems, most significantly the heart, lungs, kidneys, and central nervous system. The most common manifestation of IL-2 toxicity is capillary leak syndrome, resulting in a hypovolemic state and fluid accumulation in the extravascular space. Capillary leak syndrome can contribute significantly to development of oliguria, ischemia, and confusion. Safe and effective administration of high-dose IL-2 consists of five key components: (1) administration by an experienced and knowledgeable health-care team, (2) adherence to strict patient-eligibility criteria, (3) implementation of standardized administration and patient assessment guidelines, (4) adherence to administration criteria, and (5) compliance with retreatment contraindications. This article reviews high-dose IL-2 toxicities and symptom management strategies and provides practical guidelines to facilitate the safe and effective administration of high-dose IL-2.
尽管高剂量白细胞介素-2（IL-2，普罗力）是一种用于治疗肾细胞癌和黑色素瘤的剧毒药物，最初与治疗相关死亡率有关，但在适当的情况下，它可以安全给药。高剂量IL-2与显著的发病率相关；然而，随着临床医生对该药物经验的积累以及实施毒性预防和管理策略，毒性的发生率和严重程度有所下降。IL-2毒性可在多个器官系统中表现出来，最显著的是心脏、肺、肾脏和中枢神经系统。IL-2毒性最常见的表现是毛细血管渗漏综合征，导致血容量减少状态和血管外间隙液体蓄积。毛细血管渗漏综合征可显著促进少尿、缺血和意识障碍的发展。高剂量IL-2的安全有效给药包括五个关键要素：（1）由经验丰富且知识渊博的医疗团队给药；（2）严格遵守患者入选标准；（3）实施标准化给药和患者评估指南；（4）遵守给药标准；（5）遵守再次治疗的禁忌证。本文综述了高剂量IL-2的毒性和症状管理策略，并提供实用指南以促进高剂量IL-2的安全有效给药。
