A phase II trial of human recombinant interleukin-2 administered as a 4-day continuous infusion for children with refractory neuroblastoma, non-Hodgkin's lymphoma, sarcoma, renal cell carcinoma, and malignant melanoma. A Childrens Cancer Group study.

Recombinant human Interleukin-2 (IL-2) has been effective at inducing measurable antitumor responses in adults with renal cell carcinoma and melanoma. It also is being tested as adjuvant therapy for patients with acute myeloid leukemia after autologous bone marrow transplantation. The authors tested IL-2 in a pediatric Phase II trial using a regimen that has antitumor effects in adults and was proven to be tolerated acceptably in a prior Phase I pediatric trial. Thirty-eight patients were entered into this study of whom 36 received IL-2 and were evaluable (20 with sarcoma, 9 with neuroblastoma, 5 with renal cell carcinoma, and 1 each with melanoma and lymphoma). Interleukin-2 dose modifications were based on tolerance and toxicity, such that 46% of these patients received a 50% increase in IL-2 dose during the second week, and 81% of those receiving the elevated dose continued receiving this dose level during the third week of treatment. A single patient with renal cell carcinoma had a complete response that was maintained; the remaining 35 patients did not show objective evidence of tumor response sufficient to qualify as either a complete response or a partial response. Absolute lymphocyte counts were indicative of the immunostimulatory effect of this IL-2 regimen as observed for adults, with a median 7.2-fold increase. Nevertheless, despite immune activation, a sufficient number of patients were evaluated, indicating that IL-2 does not have measurable antitumor effects in children with large refractory sarcomas or neuroblastomas, whereas one of five children with renal cell carcinoma had a complete response, consistent with the 10-20% response rate observed in adults.