Cicek Filiz, Troschke-Meurer Sascha, Ceylan Kiraz, Jahns Luciana J, Zumpe Maxi, Siebert Nikolai, Ehlert Karoline, Lode Holger N
Department of Pediatric Hematology and Oncology, University Medicine Greifswald, Greifswald, Germany.
Front Pediatr. 2020 Dec 16;8:582820. doi: 10.3389/fped.2020.582820. eCollection 2020.
Patients with high-risk neuroblastoma treated with continuous long-term infusion of anti-GD2 antibody dinutuximab beta (DB) in combination with IL-2 show an acceptable safety profile. Here, we compared treatment tolerance with and without IL-2. Ninety-nine patients with high-risk neuroblastoma received up to five cycles of DB given as long-term infusion (10 mg/m/d, 100 mg/m; per cycle) with IL-2 (53 patients; regimen A; 6 × 10 IU/m/d; 60 × 10 IU/m/cycle) and without IL-2 (46 patients; regimen B) in a single-center compassionate use program. Clinical parameters (body temperature, vital signs, Lansky performance score), laboratory values [C-reactive protein, IFN-γ, IL-6, and IL-18 (cycle 1)], and requirement of i.v. co-medication (e.g., morphine, metamizole) were systematically assessed. Patients with stable clinical parameters and that did not require co-medication were defined as potential "outpatient candidates." Patients showed higher levels of body temperature and CRP in regimen A compared to B. However, IL-6 serum concentrations were similar in pts of both cohorts in the first cycle. Patients receiving regimen B showed a shorter time to achieve normal vital parameters and required less co-medication compared to patients in regimen A that resulted in a shorter median time period to discharge and to achieve a potential outpatient status (6d regimen A and 3-5d regimen B after start of antibody infusion, respectively). This study shows that omitting IL-2 from immunotherapy with DB allows reduced co-medication and hospitalization time and therefore results in improved quality of life in patients with high-risk neuroblastoma.
接受抗GD2抗体地努图希单抗β(DB)持续长期输注联合白细胞介素-2(IL-2)治疗的高危神经母细胞瘤患者显示出可接受的安全性。在此,我们比较了联合和不联合IL-2治疗的耐受性。99例高危神经母细胞瘤患者在一项单中心同情用药项目中接受了多达五个周期的DB长期输注(10mg/m²/天,100mg/m²;每周期),其中53例患者联合IL-2(方案A;6×10⁶IU/m²/天;60×10⁶IU/m²/周期),46例患者不联合IL-2(方案B)。系统评估了临床参数(体温、生命体征、兰斯基表现评分)、实验室值[C反应蛋白、干扰素-γ、白细胞介素-6和白细胞介素-18(第1周期)]以及静脉辅助用药(如吗啡、安乃近)的需求。临床参数稳定且不需要辅助用药的患者被定义为潜在的“门诊候选者”。与方案B相比,方案A中的患者体温和C反应蛋白水平更高。然而,两个队列的患者在第1周期的白细胞介素-6血清浓度相似。与方案A的患者相比,接受方案B的患者达到正常生命参数的时间更短,所需辅助用药更少,这导致方案B的患者出院和达到潜在门诊状态的中位时间更短(抗体输注开始后,方案A为6天,方案B为3 - 5天)。这项研究表明,在DB免疫治疗中省略IL-2可减少辅助用药和住院时间,从而改善高危神经母细胞瘤患者的生活质量。