Research trials have shown that two metastatic cancers, melanoma and renal cell carcinoma (RCC), respond to infusion with high-dose Interleukin-2 (IL-2). Of patients who respond, some have complete response (remission), while others have partial response. Because of favorable trial results, the U.S. Food and Drug Administration (FDA) has approved IL-2 for treatment of both metastatic melanoma and RCC.
Providence Cancer Center reports that 28% of 500 patients treated with IL-2 between 1997 and 2012 responded. Response rates are similar for both types of cancer. Despite such positive results, it seems IL-2 is often not discussed, nor offered to patients with metastatic melanoma nor metastatic RCC in many medical centers.
Lisa Taylor Huff was diagnosed with kidney failure caused by renal cell carcinoma (RCC) in December 2014. Doctors removed the affected kidney as quickly as possible. With early detection, RCC can be surgically removed with a high probability of survival; Lisa hoped for this outcome.
Unfortunately, RCC often advances outside the kidney before symptoms appear. CT scans revealed small metastatic tumors in Lisa’s lungs and lymph nodes and her medical team recommended a course of targeted chemotherapy using sunitinib (Pfizer trade name is Sutent) to treat the metastatic tumors.
Eddy and I visited Lisa in Paris just as she was beginning chemotherapy. She hosted us for lunch in Montmartre followed by a guided tour of the Eiffel. Her exuberance and love for Paris and her Parisian family was evident in all out interactions. Lisa had recovered from kidney removal surgery, her energy had returned, and she was optimistic that Sutent would be tolerable and effective against her cancer.
A few weeks after leaving Paris, we learned that Lisa’s treatment had been terminated because her body was not responding to the treatment and the side effects were causing problems in daily life. Lisa’s health declined precipitously and she died in early July 2015.
To my knowledge, Lisa’s medical team never discussed treatment with IL-2 with her. A treatment with about a 25% chance of improving her disease was not offered nor discussed. This is hard for me to accept, especially since another personal friend with the same diagnosis is disease-free three years after receiving IL-2 at Providence.
This is not a critique of French medical care, which is excellent. Rather this is a my critique (based on limited anecdotal evidence) of medical teams who are not offering IL-2 to their metastatic melanoma and RCC patients.
I am suspicious that many medical teams are choosing not to offer IL-2 because:
1. IL-2 requires blood pressure and heart rate telemetry as well as nursing staff with special training. Most medical centers are not set up to administer IL-2, and offering it means referring the patient to another medical team.
2. A full course of IL-2 requires 6 weeks of hospitalization. Some patients will balk at this requirement, especially if the alternative is a pill to be taken daily.
3. IL-2 is recommended for patients who are in excellent health (apart from their terminal cancer diagnosis). Not many people are feeling robustly healthy, especially when they’ve just been given a terminal diagnosis.
4. About 75% of metastatic cancer patients do not respond to IL-2. Patients may assume that if they were unlucky enough to get cancer, they will be unlucky when it comes to the efficacy of IL-2.
Hospital administrators and medical teams might rationalize opting for targeted chemotherapies, which generally are easier to administer, and offer somewhat more favorable response rates. But today’s targeted chemotherapies do not offer the possibility for durable complete remission.
Here’s the clincher: If IL-2 treatment fails, then targeted chemotherapies are available as a fallback, whereas IL-2 will invariably fail if not given prior to any other targeted chemotherapy.