Congress Abstracts 2004

86

HIGH DOSE IL-2 IN THE TREATMENT OF METASTATIC MELANOMA AND METASTATIC RENAL CELL CARCINOMA. Theresa Woodrum, RN, Nebraska Medical Center, Omaha, NE.

High-dose IL-2 holds promise for a subset of individuals with poor-prognosis metastatic melanoma and renal cell carcinoma, but patient outcome requires astute nursing management of side effects to prevent life-threatening complications and to provide for strict compliance with the treatment protocol.

The treatment schedule involves IL-2 600,000 iu/kg every 8 hours X 14 doses, 10 days of no IL-2, and another series of 600,000 iu/kg every 8 hours X 14 doses. IL-2 restores T cell mediated immune responses, enhances natural killer cell activity, and generates lymphokine-activated killer cell activity. This presentation will use case examples to illustrate nursing care required, application of the toxicity criteria for dosing decisions, and evaluation of response. The response is determined 4–6 weeks after the first course, and a second course may then be administered. Each dose of IL-2 must be administered on schedule without time delay. If symptoms warrant concern, a dose may be omitted based on a strict scoring system, but never delayed or reduced. Toxicities which are mediated through lymphoid infiltration secondary to capillary leak syndrome and the local effects of cytokines potentially involve all body systems and include problems such as sinus tach, diarrhea, bleeding, rigors, electrolyte imbalance, confusion, shortness of breath, and weight gain. Toxicities are generally reversible 2–3 days after therapy is discontinued if additional complications are avoided.

Examples of potential problems nursing must address include hypotension and cardiac arrhythmias that require monitoring and pressors; and capillary leak syndrome that can result in pleural effusions, and hypoxemia severe enough to require ventilatory assistance. Patients must be monitored closely for infections due to IL-2-induced defects in neutrophil chemotaxis. In addition to the monitoring required, nurses must orchestrate the administration of multiple medications for the prevention and treatment of side effects. Steroids are avoided because they inhibit release of tumor necrosis factor into the circulation.

Quality nursing care is imperative for the patient’s well-being and directly influences the doses of IL-2 that can be administered. Nurses need to be able to recognize problems early; interpret cardiac monitoring, lab, and vital signs; initiate interventions; and facilitate the accurate recording of data.

The information presented in this poster will foster increased understanding of the actions of IL-2, the potential cascade of events secondary to capillary leak syndrome, and the critical role of nursing in the care of patients receiving this protocol.