Phase II trial of hu14.18-IL2 for patients with metastatic melanoma
Phase I testing of the hu14.18-IL2 immunocytokine in melanoma patients showed immune activation, reversible toxicities, and a maximal tolerated dose of 7.5 mg/m 2 /day. In this phase II study, 14 patients with measurable metastatic melanoma were scheduled to receive hu14.18-IL2 at 6 mg/m 2 /day as 4...
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| Veröffentlicht in: | Cancer Immunology, Immunotherapy Immunotherapy, 2012-12, Vol.61 (12), p.2261-2271 |
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| creator | Albertini, Mark R. Hank, Jacquelyn A. Gadbaw, Brian Kostlevy, Jordan Haldeman, Jennifer Schalch, Heidi Gan, Jacek Kim, KyungMann Eickhoff, Jens Gillies, Stephen D. Sondel, Paul M. |
| description | Phase I testing of the hu14.18-IL2 immunocytokine in melanoma patients showed immune activation, reversible toxicities, and a maximal tolerated dose of 7.5 mg/m
2
/day. In this phase II study, 14 patients with measurable metastatic melanoma were scheduled to receive hu14.18-IL2 at 6 mg/m
2
/day as 4-h intravenous infusions on Days 1, 2, and 3 of each 28 day cycle. Patients with stable disease (SD) or regression following cycle 2 could receive two additional treatment cycles. The primary objective was to evaluate antitumor activity and response duration. Secondary objectives evaluated adverse events and immunologic activation. All patients received two cycles of treatment. One patient had a partial response (PR) [1 PR of 14 patients = response rate of 7.1 %; confidence interval, 0.2–33.9 %], and 4 patients had SD and received cycles 3 and 4. The PR and SD responses lasted 3–4 months. All toxicities were reversible and those resulting in dose reduction included grade 3 hypotension (2 patients) and grade 2 renal insufficiency with oliguria (1 patient). Patients had a peripheral blood lymphocytosis on Day 8 and increased C-reactive protein. While one PR in 14 patients met protocol criteria to proceed to stage 2 and enter 16 additional patients, we suspended stage 2 due to limited availability of hu14.18-IL2 at that time and the brief duration of PR and SD. We conclude that subsequent testing of hu14.18-IL2 should involve melanoma patients with minimal residual disease based on compelling preclinical data and the confirmed immune activation with some antitumor activity in this study. |
| doi_str_mv | 10.1007/s00262-012-1286-5 |
| format | Article |
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2
/day. In this phase II study, 14 patients with measurable metastatic melanoma were scheduled to receive hu14.18-IL2 at 6 mg/m
2
/day as 4-h intravenous infusions on Days 1, 2, and 3 of each 28 day cycle. Patients with stable disease (SD) or regression following cycle 2 could receive two additional treatment cycles. The primary objective was to evaluate antitumor activity and response duration. Secondary objectives evaluated adverse events and immunologic activation. All patients received two cycles of treatment. One patient had a partial response (PR) [1 PR of 14 patients = response rate of 7.1 %; confidence interval, 0.2–33.9 %], and 4 patients had SD and received cycles 3 and 4. The PR and SD responses lasted 3–4 months. All toxicities were reversible and those resulting in dose reduction included grade 3 hypotension (2 patients) and grade 2 renal insufficiency with oliguria (1 patient). Patients had a peripheral blood lymphocytosis on Day 8 and increased C-reactive protein. While one PR in 14 patients met protocol criteria to proceed to stage 2 and enter 16 additional patients, we suspended stage 2 due to limited availability of hu14.18-IL2 at that time and the brief duration of PR and SD. We conclude that subsequent testing of hu14.18-IL2 should involve melanoma patients with minimal residual disease based on compelling preclinical data and the confirmed immune activation with some antitumor activity in this study.</description><identifier>ISSN: 0340-7004</identifier><identifier>EISSN: 1432-0851</identifier><identifier>DOI: 10.1007/s00262-012-1286-5</identifier><identifier>PMID: 22678096</identifier><identifier>CODEN: CIIMDN</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer-Verlag</publisher><subject>Adult ; Aged ; Antibodies ; Antibodies, Monoclonal - administration & dosage ; Antibodies, Monoclonal - adverse effects ; Antibodies, Monoclonal - immunology ; Antibodies, Neoplasm - immunology ; Antineoplastic agents ; Antineoplastic Agents - administration & dosage ; Antineoplastic Agents - adverse effects ; Antineoplastic Agents - immunology ; Antitumor activity ; Biological and medical sciences ; C-reactive protein ; Cancer ; Cancer Research ; Clinical trials ; Cytokines ; Cytotoxicity ; Data processing ; Dermatology ; Drug Administration Schedule ; Drug dosages ; Female ; Genes ; Humans ; Hypotension ; Immune response ; Immunology ; Immunotherapy ; Infusions, Intravenous ; Interleukin-2 - administration & dosage ; Interleukin-2 - adverse effects ; Interleukin-2 - immunology ; Intravenous administration ; Lymphocytosis ; Male ; Medical sciences ; Medicine ; Medicine & Public Health ; Melanoma ; Melanoma - drug therapy ; Melanoma - immunology ; Melanoma - pathology ; Metastases ; Metastasis ; Middle Aged ; minimal residual disease ; Oncology ; Original Article ; Patients ; Peripheral blood ; Pharmacology. Drug treatments ; Public health ; Renal insufficiency ; Response rates ; Toxicity ; Treatment Outcome ; Tumors ; Tumors of the skin and soft tissue. Premalignant lesions ; Young Adult</subject><ispartof>Cancer Immunology, Immunotherapy, 2012-12, Vol.61 (12), p.2261-2271</ispartof><rights>Springer-Verlag 2012</rights><rights>2014 INIST-CNRS</rights><rights>Springer-Verlag Berlin Heidelberg 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c478t-de5a43e26b2f69b8ed5976ea53ae9c4e6c510f2943aca9f6671b35648fdc352f3</citedby><cites>FETCH-LOGICAL-c478t-de5a43e26b2f69b8ed5976ea53ae9c4e6c510f2943aca9f6671b35648fdc352f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00262-012-1286-5$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00262-012-1286-5$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26680702$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22678096$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Albertini, Mark R.</creatorcontrib><creatorcontrib>Hank, Jacquelyn A.</creatorcontrib><creatorcontrib>Gadbaw, Brian</creatorcontrib><creatorcontrib>Kostlevy, Jordan</creatorcontrib><creatorcontrib>Haldeman, Jennifer</creatorcontrib><creatorcontrib>Schalch, Heidi</creatorcontrib><creatorcontrib>Gan, Jacek</creatorcontrib><creatorcontrib>Kim, KyungMann</creatorcontrib><creatorcontrib>Eickhoff, Jens</creatorcontrib><creatorcontrib>Gillies, Stephen D.</creatorcontrib><creatorcontrib>Sondel, Paul M.</creatorcontrib><title>Phase II trial of hu14.18-IL2 for patients with metastatic melanoma</title><title>Cancer Immunology, Immunotherapy</title><addtitle>Cancer Immunol Immunother</addtitle><addtitle>Cancer Immunol Immunother</addtitle><description>Phase I testing of the hu14.18-IL2 immunocytokine in melanoma patients showed immune activation, reversible toxicities, and a maximal tolerated dose of 7.5 mg/m
2
/day. In this phase II study, 14 patients with measurable metastatic melanoma were scheduled to receive hu14.18-IL2 at 6 mg/m
2
/day as 4-h intravenous infusions on Days 1, 2, and 3 of each 28 day cycle. Patients with stable disease (SD) or regression following cycle 2 could receive two additional treatment cycles. The primary objective was to evaluate antitumor activity and response duration. Secondary objectives evaluated adverse events and immunologic activation. All patients received two cycles of treatment. One patient had a partial response (PR) [1 PR of 14 patients = response rate of 7.1 %; confidence interval, 0.2–33.9 %], and 4 patients had SD and received cycles 3 and 4. The PR and SD responses lasted 3–4 months. All toxicities were reversible and those resulting in dose reduction included grade 3 hypotension (2 patients) and grade 2 renal insufficiency with oliguria (1 patient). Patients had a peripheral blood lymphocytosis on Day 8 and increased C-reactive protein. While one PR in 14 patients met protocol criteria to proceed to stage 2 and enter 16 additional patients, we suspended stage 2 due to limited availability of hu14.18-IL2 at that time and the brief duration of PR and SD. We conclude that subsequent testing of hu14.18-IL2 should involve melanoma patients with minimal residual disease based on compelling preclinical data and the confirmed immune activation with some antitumor activity in this study.</description><subject>Adult</subject><subject>Aged</subject><subject>Antibodies</subject><subject>Antibodies, Monoclonal - administration & dosage</subject><subject>Antibodies, Monoclonal - adverse effects</subject><subject>Antibodies, Monoclonal - immunology</subject><subject>Antibodies, Neoplasm - immunology</subject><subject>Antineoplastic agents</subject><subject>Antineoplastic Agents - administration & dosage</subject><subject>Antineoplastic Agents - adverse effects</subject><subject>Antineoplastic Agents - immunology</subject><subject>Antitumor activity</subject><subject>Biological and medical sciences</subject><subject>C-reactive protein</subject><subject>Cancer</subject><subject>Cancer Research</subject><subject>Clinical trials</subject><subject>Cytokines</subject><subject>Cytotoxicity</subject><subject>Data processing</subject><subject>Dermatology</subject><subject>Drug Administration Schedule</subject><subject>Drug dosages</subject><subject>Female</subject><subject>Genes</subject><subject>Humans</subject><subject>Hypotension</subject><subject>Immune response</subject><subject>Immunology</subject><subject>Immunotherapy</subject><subject>Infusions, Intravenous</subject><subject>Interleukin-2 - administration & dosage</subject><subject>Interleukin-2 - adverse effects</subject><subject>Interleukin-2 - immunology</subject><subject>Intravenous administration</subject><subject>Lymphocytosis</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Melanoma</subject><subject>Melanoma - drug therapy</subject><subject>Melanoma - immunology</subject><subject>Melanoma - pathology</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Middle Aged</subject><subject>minimal residual disease</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Patients</subject><subject>Peripheral blood</subject><subject>Pharmacology. Drug treatments</subject><subject>Public health</subject><subject>Renal insufficiency</subject><subject>Response rates</subject><subject>Toxicity</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><subject>Tumors of the skin and soft tissue. Premalignant lesions</subject><subject>Young Adult</subject><issn>0340-7004</issn><issn>1432-0851</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kElLBDEQhYMoOi4_wIs0iOCltbInRxlcBgb0oOeQySROSy9j0o34780444LgqYqqr-o9HkLHGC4wgLxMAESQEjApMVGi5FtohBnNE8XxNhoBZVBKALaH9lN6yQ0BrXfRHiFCKtBihMYPC5t8MZkUfaxsXXShWAyYXWBVTqakCF0slravfNun4q3qF0Xje5v6PHK5rW3bNfYQ7QRbJ3-0qQfo6eb6cXxXTu9vJ-OraemYVH0599wy6omYkSD0TPk511J4y6n12jEvHMcQiGbUOquDEBLPKBdMhbmjnAR6gM7Xf5exex186k1TJefr7MJ3QzKYcCkFJUpl9PQP-tINsc3uDMZZVQMHkim8plzsUoo-mGWsGhvfDQazStisEzY5YbNK2PB8c7L5PMwaP_---Io0A2cbwCZn6xBt66r0wwmhQH6KkzWX8qp99vGXxX_VPwCi84_p</recordid><startdate>20121201</startdate><enddate>20121201</enddate><creator>Albertini, Mark R.</creator><creator>Hank, Jacquelyn A.</creator><creator>Gadbaw, Brian</creator><creator>Kostlevy, Jordan</creator><creator>Haldeman, Jennifer</creator><creator>Schalch, Heidi</creator><creator>Gan, Jacek</creator><creator>Kim, KyungMann</creator><creator>Eickhoff, Jens</creator><creator>Gillies, Stephen D.</creator><creator>Sondel, Paul M.</creator><general>Springer-Verlag</general><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope></search><sort><creationdate>20121201</creationdate><title>Phase II trial of hu14.18-IL2 for patients with metastatic melanoma</title><author>Albertini, Mark R. ; Hank, Jacquelyn A. ; Gadbaw, Brian ; Kostlevy, Jordan ; Haldeman, Jennifer ; Schalch, Heidi ; Gan, Jacek ; Kim, KyungMann ; Eickhoff, Jens ; Gillies, Stephen D. ; Sondel, Paul M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c478t-de5a43e26b2f69b8ed5976ea53ae9c4e6c510f2943aca9f6671b35648fdc352f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Antibodies</topic><topic>Antibodies, Monoclonal - administration & dosage</topic><topic>Antibodies, Monoclonal - adverse effects</topic><topic>Antibodies, Monoclonal - immunology</topic><topic>Antibodies, Neoplasm - immunology</topic><topic>Antineoplastic agents</topic><topic>Antineoplastic Agents - administration & dosage</topic><topic>Antineoplastic Agents - adverse effects</topic><topic>Antineoplastic Agents - immunology</topic><topic>Antitumor activity</topic><topic>Biological and medical sciences</topic><topic>C-reactive protein</topic><topic>Cancer</topic><topic>Cancer Research</topic><topic>Clinical trials</topic><topic>Cytokines</topic><topic>Cytotoxicity</topic><topic>Data processing</topic><topic>Dermatology</topic><topic>Drug Administration Schedule</topic><topic>Drug dosages</topic><topic>Female</topic><topic>Genes</topic><topic>Humans</topic><topic>Hypotension</topic><topic>Immune response</topic><topic>Immunology</topic><topic>Immunotherapy</topic><topic>Infusions, Intravenous</topic><topic>Interleukin-2 - administration & dosage</topic><topic>Interleukin-2 - adverse effects</topic><topic>Interleukin-2 - immunology</topic><topic>Intravenous administration</topic><topic>Lymphocytosis</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Melanoma</topic><topic>Melanoma - drug therapy</topic><topic>Melanoma - immunology</topic><topic>Melanoma - pathology</topic><topic>Metastases</topic><topic>Metastasis</topic><topic>Middle Aged</topic><topic>minimal residual disease</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Patients</topic><topic>Peripheral blood</topic><topic>Pharmacology. Drug treatments</topic><topic>Public health</topic><topic>Renal insufficiency</topic><topic>Response rates</topic><topic>Toxicity</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><topic>Tumors of the skin and soft tissue. Premalignant lesions</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Albertini, Mark R.</creatorcontrib><creatorcontrib>Hank, Jacquelyn A.</creatorcontrib><creatorcontrib>Gadbaw, Brian</creatorcontrib><creatorcontrib>Kostlevy, Jordan</creatorcontrib><creatorcontrib>Haldeman, Jennifer</creatorcontrib><creatorcontrib>Schalch, Heidi</creatorcontrib><creatorcontrib>Gan, Jacek</creatorcontrib><creatorcontrib>Kim, KyungMann</creatorcontrib><creatorcontrib>Eickhoff, Jens</creatorcontrib><creatorcontrib>Gillies, Stephen D.</creatorcontrib><creatorcontrib>Sondel, Paul M.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>Cancer Immunology, Immunotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Albertini, Mark R.</au><au>Hank, Jacquelyn A.</au><au>Gadbaw, Brian</au><au>Kostlevy, Jordan</au><au>Haldeman, Jennifer</au><au>Schalch, Heidi</au><au>Gan, Jacek</au><au>Kim, KyungMann</au><au>Eickhoff, Jens</au><au>Gillies, Stephen D.</au><au>Sondel, Paul M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Phase II trial of hu14.18-IL2 for patients with metastatic melanoma</atitle><jtitle>Cancer Immunology, Immunotherapy</jtitle><stitle>Cancer Immunol Immunother</stitle><addtitle>Cancer Immunol Immunother</addtitle><date>2012-12-01</date><risdate>2012</risdate><volume>61</volume><issue>12</issue><spage>2261</spage><epage>2271</epage><pages>2261-2271</pages><issn>0340-7004</issn><eissn>1432-0851</eissn><coden>CIIMDN</coden><abstract>Phase I testing of the hu14.18-IL2 immunocytokine in melanoma patients showed immune activation, reversible toxicities, and a maximal tolerated dose of 7.5 mg/m
2
/day. In this phase II study, 14 patients with measurable metastatic melanoma were scheduled to receive hu14.18-IL2 at 6 mg/m
2
/day as 4-h intravenous infusions on Days 1, 2, and 3 of each 28 day cycle. Patients with stable disease (SD) or regression following cycle 2 could receive two additional treatment cycles. The primary objective was to evaluate antitumor activity and response duration. Secondary objectives evaluated adverse events and immunologic activation. All patients received two cycles of treatment. One patient had a partial response (PR) [1 PR of 14 patients = response rate of 7.1 %; confidence interval, 0.2–33.9 %], and 4 patients had SD and received cycles 3 and 4. The PR and SD responses lasted 3–4 months. All toxicities were reversible and those resulting in dose reduction included grade 3 hypotension (2 patients) and grade 2 renal insufficiency with oliguria (1 patient). Patients had a peripheral blood lymphocytosis on Day 8 and increased C-reactive protein. While one PR in 14 patients met protocol criteria to proceed to stage 2 and enter 16 additional patients, we suspended stage 2 due to limited availability of hu14.18-IL2 at that time and the brief duration of PR and SD. We conclude that subsequent testing of hu14.18-IL2 should involve melanoma patients with minimal residual disease based on compelling preclinical data and the confirmed immune activation with some antitumor activity in this study.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer-Verlag</pub><pmid>22678096</pmid><doi>10.1007/s00262-012-1286-5</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Cancer Immunology, Immunotherapy, 2012-12, Vol.61 (12), p.2261-2271 |
| issn | 0340-7004 1432-0851 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals; PubMed Central |
| subjects | Adult Aged Antibodies Antibodies, Monoclonal - administration & dosage Antibodies, Monoclonal - adverse effects Antibodies, Monoclonal - immunology Antibodies, Neoplasm - immunology Antineoplastic agents Antineoplastic Agents - administration & dosage Antineoplastic Agents - adverse effects Antineoplastic Agents - immunology Antitumor activity Biological and medical sciences C-reactive protein Cancer Cancer Research Clinical trials Cytokines Cytotoxicity Data processing Dermatology Drug Administration Schedule Drug dosages Female Genes Humans Hypotension Immune response Immunology Immunotherapy Infusions, Intravenous Interleukin-2 - administration & dosage Interleukin-2 - adverse effects Interleukin-2 - immunology Intravenous administration Lymphocytosis Male Medical sciences Medicine Medicine & Public Health Melanoma Melanoma - drug therapy Melanoma - immunology Melanoma - pathology Metastases Metastasis Middle Aged minimal residual disease Oncology Original Article Patients Peripheral blood Pharmacology. Drug treatments Public health Renal insufficiency Response rates Toxicity Treatment Outcome Tumors Tumors of the skin and soft tissue. Premalignant lesions Young Adult |
| title | Phase II trial of hu14.18-IL2 for patients with metastatic melanoma |
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