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Isolated left ventricular filling abnormalities may predict interleukin-2-induced cardiovascular toxicity
G Citterio1, G Fragasso, E Rossetti
1Divisione di Medicina II, IRCCS H S. Raffaele, Milan, Italy.
Journal of Immunotherapy with Emphasis on Tumor Immunology : Official Journal of the Society for Biological Therapy
|March 1, 1996
Summary
Serial echocardiography can predict cardiac events during high-dose Interleukin-2 (IL-2) cancer therapy. An abnormal E/A ratio before treatment indicates higher risk, suggesting closer monitoring or dose adjustment for patients receiving IL-2 for renal cell carcinoma or melanoma.
Area of Science:
- Cardiology
- Oncology
- Pharmacology
Background:
- High-dose Interleukin-2 (IL-2) is effective for metastatic renal cell carcinoma (RCC) and malignant melanoma (MM).
- Intravenous IL-2 administration is associated with significant cardiovascular toxicities (hypotension, arrhythmias, ischemia), often necessitating dose reduction or treatment cessation.
- Current methods do not reliably predict these adverse cardiac events before treatment initiation.
Purpose of the Study:
- To evaluate the reliability of serial echocardiography in predicting cardiac adverse effects during IL-2 administration.
- To assess left ventricular systolic function and diastolic transmitral flow patterns before and after IL-2 infusions.
Main Methods:
- Nineteen patients with metastatic RCC or MM underwent two-dimensional and Doppler echocardiography before and after 28 continuous intravenous infusions (CIVI) of IL-2.
- Assessment included left ventricular systolic function and diastolic transmitral flow patterns, specifically the E/A ratio and atrial contribution to filling.
- Correlation between echocardiographic findings and major cardiovascular events was analyzed.
Main Results:
- Significant changes in left ventricular filling were observed post-IL-2: decreased E/A ratio (1.12 to 0.83) and increased atrial contribution (37.75% to 49.43%).
- Eight major cardiovascular events occurred, leading to IL-2 withdrawal.
- An abnormal basal E/A ratio (< 1.0) was significantly associated with a higher incidence of major cardiovascular events (p < 0.05).
Conclusions:
- Doppler transmitral flow pattern analysis is a valuable, accessible tool for monitoring cardiac changes during CIVI IL-2 therapy.
- Pre-treatment E/A ratio can predict major cardiovascular events in patients receiving IL-2.
- Patients with a basal E/A ratio < 1.0 require closer monitoring and potential dose adjustment to mitigate cardiovascular toxicity.