Rapid deterioration in quality of life during interleukin-2- and α-interferon-based home therapy of renal cell carcinoma is associated with a good outcome

Abstract

We conducted a prospective quality-of-life analysis during outpatient immunotherapy in 22 patients with progressive metastatic renal cell carcinoma (RCC) treated with subcutaneous interferon-a2a and subcutaneous interleukin-2. Patients' quality of life was assessed by the European Organization for Research and Treatment of Cancer quality-of-life questionnaire QLQ-C30 before (week 0) and once during immunotherapy (week 3). Advanced renal cancer patients completed a total of 30 questionnaires before therapy (week 0) and after 3 weeks of therapy. Their mean quality of life (global-quality-of-health status) deteriorated significantly, from 64 to 41 (Pp0.001) during the first 3 weeks after treatment initiation, due to a mean reduction in physical (from 82 to 65; Pp0.001), emotional (from 77 to 61; Pp0.01), social (from 78 to 55; Pp0.01), and role functioning (from 82 to 58; Pp0.01). In contrast, cognitive functioning did not differ significantly from pretreatment scores after 3 weeks of therapy. In addition, during the first 3 weeks, appetite loss (from 18 to 59; Pp0.01), fatigue (from 33 to 56; Pp0.01), nausea/vomiting (from 10 to 26; Pp0.01), sleep disturbance (from 27 to 47; Pp0.01), diarrhoea (from five to 27; Pp0.01), and pain (from 20 to 32; Pp0.05) were significantly increased, while quality-of-life symptoms such as dyspnoea, and constipation were not significantly influenced by therapy. Complete response to RCC outpatient immunotherapy was associated with the most predominant reduction in functional quality of life when compared against patients in progressive or stable disease or partial tumour response. In conclusion, quality-of-life analysis during outpatient immunotherapy yielded modest changes in patients' health status 3 weeks after therapy initiation. Since the rapid decline in functional quality-of-life was associated with therapeutic efficacy, it is suggested that quality-of-life analysis might serve as an early indicator for immunotherapy response in metastatic RCC.

Spinal injection of IL-2 or IL-15 alters mechanical and thermal withdrawal thresholds in rats

“…One set of evidence indicate that increased levels of IL-2 in and around sensory nerve endings or in the central nervous system promote nociceptive behaviors. Systemic administration of IL-2 in cancer patients induces pain at the site of injection, bone pain, and painful peripheral neuropathy [37][38][39]. Experimental studies in animals replicate many of these clinical observations.…”

Efectos de la inmunoterapia en el paciente adulto en el domicilio: revisión sistemática

“…Cuatro de ellos (1,(6)(7)(8) En estos artículos se comparan tratamientos inmunoterápicos (Interleucina-2 (IL-2) y vacuna contra el virus influenza, principalmente) aplicados en el hogar, a nivel residencial (2) y a nivel ambulatorio (7). En uno de ellos se evaluaba la calidad de vida de los pacientes tras recibir su tratamiento, mediante el Cuestionario de Calidad de Vida de la Organización Europea para la Investigación y Tratamiento del Cáncer (EORTC-QLQ-C30) (6).…”

“…Por último, en los 4 trabajos de Atzpodien et al (1,(6)(7)(8) se concluía que el tratamiento inmunoterápico administrado de forma ambulatoria puede mejorar la calidad de vida de los pacientes al disminuir la toxicidad sistémica. Este hecho se contrarresta con un artículo posterior, que concluye que la reducción de la calidad de vida en los pacientes referente a su funcionamiento físico, psicología y relaciones sociales tras el tratamiento inmunoterápico ambulatorio puede servir de indicador temprano para la respuesta e incluso para la supervivencia de los pacientes.…”

“…Solo en un trabajo se hablaba de las terapias alérgicas (9), hecho que difiere con la elevada importancia que nombraba Canonica et al y Bachert et al sobre el elevado número de personas en Europa con alergia estacional (15,16). Del mismo modo, en uno de los artículos estudiados se ponía de manifiesto la calidad de vida de los pacientes, siendo este el único en donde se cuantificaba el bienestar de los pacientes ante el empleo del tratamiento de elección (6).…”

Beyond Traditional Outcomes: Improving Quality of Life in Patients with Renal Cell Carcinoma

“…After 3 weeks of at-home therapy with low-dose IL-2 ϩ IFN-␣2a ϩ 13-cis-retinoic acid, those patients who achieved a complete response (CR) to therapy had the most prominent decreases from baseline in HRQOL, caused mainly by decreases in physical functioning, psychological distress, impairment of social activities, and limitation in working capacity. The investigators hypothesized that these results were related to the underlying mechanism of immunotherapy-based treatment, such that patients with more intact immune systems experienced these HRQOL decreases because of exogenous cytokine-mediated immune activation [7].…”