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Gastrointestinal perforations associated with interleukin-2 administration.

David M Heimann1, Douglas J Schwartzentruber

  • 1Center for Cancer Research, Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA. David_Heimann@nih.gov

Journal of Immunotherapy (Hagerstown, Md. : 1997)
|April 13, 2004
PubMed
Summary

Gastrointestinal perforation is a rare complication of high-dose interleukin-2 (IL-2) cancer therapy. Early diagnosis via radiography and surgical intervention allow for safe retreatment with IL-2.

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Immunotherapy

Background:

  • High-dose interleukin-2 (IL-2) offers significant regression rates in metastatic melanoma and renal cell carcinoma.
  • Gastrointestinal (GI) perforation is a rare but severe complication associated with IL-2 therapy.

Purpose of the Study:

  • To evaluate the incidence and characteristics of GI perforation in patients treated with IL-2.
  • To assess the safety of retreatment with IL-2 after GI perforation.

Main Methods:

  • Retrospective review of 1,797 patients treated with IL-2 at the National Cancer Institute (NCI) between 1984 and 2002.
  • Comprehensive review of English literature for reported cases of GI perforation during IL-2 therapy.

Main Results:

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  • Eight cases (0.44%) of GI perforation occurred among NCI patients, primarily with high-dose intravenous IL-2.
  • Symptoms included abdominal pain; radiographic evaluation was key for diagnosing free intraperitoneal air.
  • Locations varied (stomach, small bowel, appendix, colon); all patients underwent successful surgery, and four were retreated with IL-2.

Conclusions:

  • Early diagnosis of GI perforation during IL-2 therapy relies on prompt radiographic evaluation.
  • Patients can be safely retreated with IL-2 following recovery from perforation and thorough assessment.