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Clinical Trials > Side Effects

Most treatment-related side effects are rapidly reversible1-3

Like most immunotherapies, mRCC or mM patients are likely to experience side effects with treatment. With Proleukin1-3:

Treatment-related side effects can be managed at specialized IL-2 Treatment Centers.

Long-term sequelae associated with Proleukin are extremely rare and may include myocardial infarction, bowel perforation, and gangrene.3

Most treatment-related side effects are manageable, rapidly reversible, and improve within 2 to 3 days of stopping therapy.1-3

Proleukin administration has been associated with capillary leak syndrome.1 Please see full Prescribing Information and complete Boxed Warning.

Your patients will be well cared for at specialized IL-2 Treatment Centers

Throughout treatment, a specially trained team of healthcare professionals will:

  • Monitor your patients 24/7 to anticipate treatment-related side effects and to provide rapid response1,3
  • Do everything they can to keep your patients as comfortable as possible throughout treatment
  • Withhold doses of Proleukin at any stage when needed to assist with adverse event management1

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Some specialized IL-2 Treatment Centers have over 20 years of real-world clinical experience administering Proleukin and have provided effective strategies to manage side effects.1,4

Common Adverse Events Reported in ≥ 10% of Patients (Any Grade, n = 525)1

side-effect-table1 side-effect-table2

aCardiovascular disorder: fluctuations in blood pressure, asymptomatic ECG changes, CHF.
bLung disorder: physical findings associated with pulmonary congestion, rales, rhonchi.
cRespiratory disorder: ARDS, CXR infiltrates, unspecified pulmonary changes.

Life-Threatening (Grade 4) Adverse Events Reported in ≥ 1% of Patients (n = 525)1

side-effect-table3 side-effect-table4

dCardiovascular disorder: fluctuations in blood pressure.
eCoagulation disorder: intravascular coagulopathy.
fRespiratory disorder: ARDS, respiratory failure, intubation.
Talking to patients
You can help manage expectations by:
• 
Explaining that side effects are common with most immunotherapies, including Proleukin1
• 
Reminding patients that everyone is unique and will respond to side effects differently1
• 
Reassuring patients that they will be monitored 24/7 by a multidisciplinary team trained in administering Proleukin and managing side effects1-3
• 
Explaining to patients that most treatment-related side effects improve 2 to 3 days after stopping treatment with Proleukin1-3
Providing hope is possible with Proleukin.
Providing hope is possible with Proleukin.

Objective response was seen in 16% of mM patients (6% complete and 10% partial responders) and in 15% of mRCC patients (7% complete and 8% partial responders).1

References: 1. Proleukin [package insert]. Yardley, PA: Clinigen, Inc; 2019. 2. Fyfe G, Fisher RI, Rosenberg SA, Sznol M, Parkinson DR, Louie AC. Results of treatment of 255 patients with metastatic renal cell carcinoma who received high-dose recombinant interleukin-2 therapy. J Clin Oncol. 1995;13(3):688-696. 3. Atkins MB, Lotze MT, Dutcher JP, et al. High-dose recombinant interleukin 2 therapy for patients with metastatic melanoma: analysis of 270 patients treated between 1985 and 1993. J Clin Oncol. 1999;17(7):2105-2116. 4. Dutcher JP, Schwartzentruber DJ, Kaufman HL, et al. High dose interleukin-2 (aldesleukin)—expert consensus on best management practices—2014. J Immunother Cancer. 2014;2(1):26. 5. Fisher RI, Rosenberg SA, Fyfe G. Long-term survival update for high-dose recombinant interleukin-2 in patients with renal cell carcinoma. Cancer J Sci Am. 2000;6(suppl 1):S55-S57. 6. Atkins MB, Kunkel L, Sznol M, Rosenberg SA. High-dose recombinant interleukin-2 therapy in patients with metastatic melanoma: long-term survival update. Cancer J Sci Am. 2000;6(suppl 1):S11-S14.

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Proleukin® (aldesleukin) is indicated for the treatment of adults with metastatic melanoma (mM) and metastatic renal cell carcinoma (mRCC).

Summary of Important Safety Information for Proleukin® (aldesleukin) for injection, for intravenous infusion.

Proleukin® (aldesleukin) is indicated for the treatment of adults with metastatic renal cell carcinoma (mRCC) and metastatic melanoma (mM).

Summary of Important Safety Information for Proleukin® (aldesleukin) for injection, for intravenous infusion.

WARNINGS

Therapy with Proleukin® (aldesleukin) should be restricted to patients with normal cardiac and pulmonary functions as defined by thallium stress testing and formal pulmonary function testing. Extreme caution should be used in patients with a normal thallium stress test and a normal pulmonary function test who have a history of cardiac or pulmonary disease.

Proleukin should be administered in a hospital setting under the supervision of a qualified physician experienced in the use of anticancer agents. An intensive care facility and specialists skilled in cardiopulmonary or intensive care medicine must be available.

Proleukin administration has been associated with capillary leak syndrome (CLS) which is characterized by a loss of vascular tone and extravasation of plasma proteins and fluid into the extravascular space. CLS results in hypotension and reduced organ perfusion which may be severe and can result in death. CLS may be associated with cardiac arrhythmias (supraventricular and ventricular), angina, myocardial infarction, respiratory insufficiency requiring intubation, gastrointestinal bleeding or infarction, renal insufficiency, edema, and mental status changes.

Proleukin treatment is associated with impaired neutrophil function (reduced chemotaxis) and with an increased risk of disseminated infection, including sepsis and bacterial endocarditis. Consequently, preexisting bacterial infections should be adequately treated prior to initiation of Proleukin therapy. Patients with indwelling central lines are particularly at risk for infection with gram positive microorganisms. Antibiotic prophylaxis with oxacillin, nafcillin, ciprofloxacin, or vancomycin has been associated with a reduced incidence of staphylococcal infections.

Proleukin administration should be withheld in patients developing moderate to severe lethargy or somnolence; continued administration may result in coma.

 

INDICATIONS AND USAGE

Proleukin® (aldesleukin) is indicated for the treatment of adults with metastatic renal cell carcinoma (metastatic RCC).

Proleukin is indicated for the treatment of adults with metastatic melanoma.

Careful patient selection is mandatory prior to the administration of Proleukin.

Evaluation of clinical studies to date reveals that patients with more favorable ECOG performance status (ECOG PS 0) at treatment initiation respond better to Proleukin, with a higher response rate and lower toxicity. Therefore, selection of patients for treatment should include assessment of performance status.

Experience in patients with ECOG PS > 1 is extremely limited.

 

CONTRAINDICATIONS

Proleukin® (aldesleukin) is contraindicated in patients with a known history of hypersensitivity to interleukin-2 or any component of the Proleukin formulation.

Proleukin is contraindicated in patients with an abnormal thallium stress test or abnormal pulmonary function tests and those with organ allografts. Retreatment with Proleukin is contraindicated in patients who have experienced the following drug-related toxicities while receiving an earlier course of therapy: sustained ventricular tachycardia (≥ 5 beats), cardiac arrhythmias not controlled or unresponsive to management, chest pain with ECG changes, consistent with angina or myocardial infarction, cardiac tamponade, intubation for > 72 hours, renal failure requiring dialysis > 72 hours, coma or toxic psychosis lasting > 48 hours, repetitive or difficult to control seizures, bowel ischemia/perforation, GI bleeding requiring surgery.

 

WARNINGS

Because of the severe adverse events which generally accompany Proleukin therapy at the recommended dosages, a thorough clinical evaluation should be performed to identify patients with significant heart, lung, kidney, liver or central nervous system impairment in whom Proleukin is not indicated for use. Patients with normal heart, lung, liver and central nervous system function may experience serious, life-threatening or fatal adverse events.

Should adverse events, requiring dose modification occur, dosage should be withheld rather than reduced.

Proleukin has been associated with exacerbation of preexisting autoimmune disease and inflammatory disorders. In some cases, the onset of new autoimmune diseases, such as vitiligo, may occur. Symptomatic hyperglycemia and/or diabetes mellitus have been reported during Proleukin therapy.

All patients should have thorough evaluation and treatment of CNS metastases and have a negative scan prior to receiving Proleukin therapy. New neurologic signs, symptoms, and anatomic lesions following Proleukin therapy have been reported in patients without evidence of CNS metastases. Neurologic signs and symptoms associated with Proleukin therapy usually improve after discontinuation of Proleukin therapy; however, there are reports of permanent neurologic defects. In patients with known seizure disorders, extreme caution should be exercised as Proleukin may cause seizures.

 

PRECAUTIONS

Patients should have normal cardiac, pulmonary, hepatic, and CNS function at the start of therapy. Capillary leak syndrome (CLS) begins immediately after Proleukin® (aldesleukin) treatment starts and is marked by increased capillary permeability to protein and fluids and reduced vascular tone.

Proleukin® (aldesleukin) treatment should be withheld for failure to maintain organ perfusion as demonstrated by altered mental status, reduced urine output, a fall in the systolic blood pressure below 90 mm Hg or onset of cardiac arrhythmias.

Recovery from CLS begins soon after cessation of Proleukin therapy. Usually, within a few hours, the blood pressure rises, organ perfusion is restored and reabsorption of extravasated fluid and protein begins.

Kidney and liver function are impaired during Proleukin treatment. Use of concomitant nephrotoxic or hepatotoxic medications may further increase toxicity to the kidney or liver.

Mental status changes including irritability, confusion, or depression which occur while receiving Proleukin may be due to bacteremia or early bacterial sepsis, hypoperfusion, occult CNS malignancy, or direct Proleukin-induced CNS toxicity. Patients should be evaluated for these and other causes of mental status changes. Alterations in mental status due solely to Proleukin therapy may progress for several days before recovery begins. Rarely, patients have sustained permanent neurologic deficits.

Proleukin enhancement of cellular immune function may increase the risk of allograft rejection in transplant patients.

Serious manifestations of eosinophilia involving eosinophilic infiltration of cardiac and pulmonary tissues can occur following Proleukin.

 

ADVERSE REACTIONS

The rate of drug-related deaths in the 255 metastatic RCC patients who received single-agent Proleukin® (aldesleukin) was 4% (11/255); the rate of drug-related deaths in the 270 metastatic melanoma patients who received single-agent Proleukin was 2% (6/270).

Adverse events are frequent, often serious, and sometimes fatal. The following adverse events (Grades 1-4) were seen in ≥ 30% of 525 patients (255 with metastatic kidney cancer and 270 with metastatic melanoma) treated with Proleukin: low blood pressure (71%), diarrhea (67%), low urine output (63%), chills (52%), vomiting (50%), shortness of breath (43%), rash (42%), increased bilirubin in blood (40%), decreased clotting of blood (37%), nausea (35%), confusion (34%), and decreased kidney function (33%).

Please see the full Prescribing Information, including Boxed Warning, for Proleukin® (aldesleukin) for injection, for intravenous infusion.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

The content contained in this website is not intended to be a substitute for professional medical advice related to any topic discussed. Patients are urged to consult with their treating physicians or other professionals. Never disregard professional, medical, or legal advice or delay seeking such advice because of something you have read on this website.