Aldesleukin (Intravenous)

Aldesleukin is used to treat cancer patients, who primarily suffer from melanoma and kidney cancer, though physicians may prescribe the drug to treat other forms of cancer.

Overview

Aldesleukin, which is pronounced al-des-LOO-kin, is a generic name for the names of the brand drugs Proleukin. Interleukin-2, and IL-2. The trade names for the drug are often used interchangeably with the Aldesleukin name by healthcare professionals. Classified as a cytokine, Aldesleukin is employed as an "antineoplastic (anticancer) biologic response modifer" to treat patients suffering from certain types of cancer.

Aldesleukin has immunoregulatory and antineoplastic capabilities, which gives it the capability of locating and binding to the IL-2 receptor. The drug also binds the IL-2R beta and gamma(c) chains to form a single compound in the body, while activating the tyrosine kinase Jak3. This results in the phosphorylation of tyrosine residues on the IL-2R beta chain. This reaction caused by the drug causes cytoplasmic signaling molecules to gather to the compound and to regulate enzymes associated with the newly formed compound. As a result, lymphocyte mitogenesis is enhanced, long-term growth of IL-2 dependent cell lines is stimulated, and lymphocyte cytotoxicity is promoted. The chain of reactions caused by administering the drug also induces lymphokine-activated killer (LAK) cell and natural killer (NK) cell activities. Interferon-gamma activity is also encouraged. This has the benefit of possibly promoting T cell-mediated tumor regression in the patient.

Once approved to treat one of these conditions, doctors are permitted to prescribe Aldesleukin to treat other conditions. If the doctor believes the drug will be beneficial to the patient, he or she has the discretion to administer the drug.

Conditions Treated

  • Kidney cancer
  • Metastatic melanoma

Type of Medicine

  • Cytokine

Side Effects

A note on the side effects of Aldesleukin points out that not every patient will experience all of the side effects listed. Certainly, some effects will be experienced, but, even then, the patient's physician can often determine when the side effects will present themselves, how long they will last, and to what severity they will be experienced. Even though the side effects will only last for the duration of the therapy, the patient's doctor may be able to offer options for managing them. Together, the doctor and patient may be able to minimize the side effects or to eliminate them altogether.

The most commonly experienced side effects of taking Aldesleukin include diarrhea, decreased blood pressure, chills, inability to urinate, and nausea accompanied by vomiting. Also commonly experienced, the patient may have a rash outbreak, difficulty in breathing, and changes in liver function. Mental effects can be experienced as well with the most common manifestations being memory loss and a general state of confusion.

Low blood counts may also be observed, while the individual is on Aldesleukin. While this is temporary, a decreased number of red and white blood cells and lower platelet counts can open the patient up to a risk of infection. Anemia and frequent bleeding may also result, caused by the lower blood counts.

A series of other side effects has been reported by patients, though the risk of experiencing these symptoms is lower. Only 10% to 29% of patients reported the manifestation of these side effects. Among them, frequent itching was reported, as well as the onset of a fever, which may or may not be accompanied by coughing and a general feeling of weakness. Additionally, patients have reported experiencing increased levels of fatigue and a poor appetite. Other patients reported weight gain, as well as an unexplained swelling of the arms and legs. Dizziness, infection, and irregular heartbeats have also been reported. Occasionally, the drug may also cause the patient to manifest dry or peeling skin.

In very rare instances and only where the patient is being administered of very high doses of Aldesleukin, capillary leak syndrome (or vascular leak syndrome) may be contracted. In capillary leak syndrome, fluids from the veins and capillaries leak to the tissue outside of the body's bloodstream. The effect of this condition causes low blood pressure and decreased blood flow to the body's organs. Signs that the patient may be experiencing capillary leak syndrome are swelling and substandard levels of protein in the blood, as well as low blood pressure. Although the doctor is responsible for monitoring these factors, while the individual is on Aldesleukin, the patient should notify his or her physician immediately of any changes. Such symptoms may include dizziness, particularly when changing position; sudden swelling of any part of the body; or unexplained and sudden weight change. Additionally, the patient should make the attending physician aware of low urine output, especially if it lasts as long as 8 to 12 hours. Changes in heart health should also be immediately discussed between the doctor and patient. These may include a shortness of breath, irregular heartbeat, chest pains or a difficulty of breathing.

While these are the most common side effects, there may be others not included here. Rare side effects, occurring in less than 10% of patients, have not been provided. Any unusual changes should be reported immediately to the patient's doctor.

Aldesleukin Dosage

The dosage of Aldesleukin varies, depending on the condition it's intended to treat. In treating renal cell carcinoma, the patient should be given 0.037 mg/kg (600,000 IU/kg) at eight hour intervals. The treatment should be administered via a 15 minute IV solution and the patient should not receive more than a total of 14 doses.

Following a nine day rest period, the patient can be administered another 14 doses course of treatment. In administering the drug, the patient receives a five day treatment cycle, followed by a rest, before another five day cycle can be initiated. The patient cannot receive more than a total 28 doses. Typically, renal cell/carcinoma patients require a maximum of 20 doses of Aldesleukin.

For treating patients with metastatic melanoma, Aldesleukin is administered at the same rate of 0.037 mg/kg (600,000 IU/kg) with the same general conditions. Treatment varies in the quantity of doses the patient typically receives. Where renal cell carcinoma patients may require 20 doses, metastatic melanoma patients generally only need a total of 18 doses.

Patients with impaired renal function should be monitored closely, because the risk of toxic reactions is high. If the patient does react adversely to the treatment the doctor should perform a global patient assessment in determining whether to put the treatment on hold or to stop it altogether. Lowering the dosage is not recommended. In circumstances where the toxic reaction puts the patient's life in jeopardy, he or she may be treated with an IV of dexamethasone, though this may also undo the desired effects of Aldesleukin.

Interactions

As is the case when starting any new medication or treatment, patients should take care to make sure their doctor is aware of every medication they are currently taking. This includes over the counter drugs and recreational narcotics, as any substance has the capability of adversely interacting with the new drug. In the case of Aldesleukin, patients should discuss specifically taking aspirin with their doctor and follow his or her instructions for doing so explicitly. It's also recommended that patients make their doctor aware of any vitamins or herbal remedies they're taking as well.

For a period of several months following the completion of the Aldesleukin therapy, patients may react negatively to the iodine solution used for CT scans. An adverse reaction can include nausea and vomiting, accompanied by chills and a fever. Other symptoms include diarrhea, the presentation of a rash and itching, and swelling of the limbs.

Additionally, patients are advised against receiving any vaccinations, such as the flu shot, while being treated with Aldesleukin. Patients should also tell their doctors if they are pregnant or expect to become pregnant, while being treated with Aldesleukin. Both male and female patients are warned against conceiving children, while taking the drug. The best protection methods suggested are those which present a barrier to body fluids, like condoms. Patients should ask their doctors when it is safe to resume efforts to conceive a baby, following the completion of their treatment. Breastfeeding should also be discussed between doctor and patient, following a treatment of Aldesleukin.

Warnings

There are some things patients and their doctors can do to make the Aldesleukin therapy more effective and less problematic. For instance, chills can be managed by keeping covered with a warm blanket and by drinking plenty of water. Unless the doctor advises against it, Aldesleukin patients should drink a minimum of two to three quarts of fluids for every 24 hour period. Mouth sores can also be treated, or prevented, through the use of a soft bristle toothbrush. The individual should also rinse his or her mouth out three times daily with a mixture of eight ounces of water and half to one full teaspoon of baking soda. Salt may be substituted, if baking soda is unavailable.

Patients are also advised to reduce the risk of infection by washing their hands often. Bleeding should be minimized through the use 0f electric razors. Similarly, contact sports, such as football and hockey, should be avoided throughout the duration of the treatment, as should any activity that presents a high risk of injury.

Nausea can be eliminated or reduced by eating small, infrequent meals. The patient's doctor may also prescribe anti-nausea medication, if it becomes a significant problem. Additionally, exposure to sunlight should be limited. If the patient must be outdoors for any length of time, he or she should wear a sunscreen with a rating of SPF 30 or higher and the individual should also cover up with protective clothing.

In treating possible diarrhea, the patient should ask his or her doctor about prescribing an anti-diarrhea medication. Additionally, there are some foods that will help reduce the likelihood of getting diarrhea. Again, the physician can provide the patient with resource and information on pursuing this aspect of treatment. Alcohol intake should also be eliminated or reduced as much as possible. The patient and doctor should discuss when it will be safe to resume the consumption of alcoholic beverages.

As Aldesleukin treatments can increase the patient's susceptibility to infection, he or she should be advised to avoid large gatherings. Similarly, exposure to individuals with colds or viral infections should also be eliminated.

Otherwise, patients are advised to maintain a healthy lifestyle that consists of a nutritional diet and as much exercise as they can tolerate. While on Aldesleukin, patients can engage in gentle exercise and frequent walks are encouraged. It's also advised that individuals get plenty of rest, while on the treatment regiment. If the patient experiences any unexpected symptoms or side effects, even those not discussed here, they're urged to speak with their doctor immediately. Their physician may be able to prescribe treatments or advise lifestyle changes that can help manage the symptoms of taking the drug.

Storage

Aldesleukin is stored at the hospital, where it's administered by the patient's healthcare providers. As such, there are no indications for at home storage available to patients. In the event that the patient will be required to take Aldesleukin at home, the attending physician will give the patient detailed instructions on the storage and use of the drug.

Summary

As a treatment for Metastatic renal cell carcinoma and metastatic melanoma Aldesleukin can provide relief for affected patients. While there are a number of common and rare side effects, many of them can be managed with other medications or with slight to moderate lifestyle changes. The best way to get the maximum benefit from Aldesleukin while also limiting the adverse reactions to the drug is by communicating fully with your doctor. By sharing as much as is relevant with the physician, the patient can achieve the greatest results from the therapy. The reactions that Aldesleukin can have with other substances is varied and unpredictable, so the patient and doctor should discuss all medications and vitamins taken by the patient, including over the counter substances and recreational drugs or herbal remedies. The treatment is limited and temporary, so slight lifestyle changes, such as delaying a pregnancy or abstaining from alcohol, may be a small price to pay. In the long run, it will be worth it to rid oneself of the cancer affecting his or her kidney function. Any concerns that arise before beginning Aldesleukin therapy, during the treatment, or following the completion of the regiment should be thoroughly discussed between the patient and his or her healthcare provider.

Resources
Last Reviewed:
December 10, 2017
Last Updated:
April 04, 2018