Interleukin-2 (Proleukin®, IL-2, Aldesleukin)
Last Modified: August 22, 2011
Classification: Biologic Response Modifier
Interleukin-2 is in the class of medications called biologic response modifiers. It is a type of protein called a cytokine that works to increase the production and function of various components of the body's immune system. This protein is normally produced in the body, but in small amounts. By increasing levels of IL-2, the immune system gets a kick-start (specifically T cells and natural killer cells) to attack the cancer cells.
How to Take Interleukin-2
Interleukin-2 is given in two different ways. It can be given in higher doses into a vein (intravenously) while the patient is monitored in the hospital. It can also be given in a low-dose regimen via a shot placed under the skin (subcutaneous injection). The low-dose regimen is given on an outpatient basis (at home or in the doctor's office). The actual dose is dependent on your body size. Premedication may be given to lower the risk of infusion reactions, like fever, chills, nausea, and low blood pressure.
Possible Side Effects of Interleukin-2
Keep in mind that these side effects are more common and more intense for people receiving the IV infusion as opposed to the lower dose injection regimen. There are things you can do to manage the side effects of Interleukin-2. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:
Infusion Related Side Effects
The interleukin-2 infusion (the high dose regimen) can cause a reaction that may include low blood pressure, increased heart rate or arrhythmias, shortness of breath, rash, nausea, diarrhea and joint and muscle stiffness. The infusion may be stopped or slowed down if this occurs and medications may be given to stop the reaction. These reactions generally occur within 24 hours of the dose and most often resolve when the medication is stopped Nearly all patients on the high dose regimen will experience flushing of the face and body or skin rash.
This occurs in a majority of patients, no matter the regimen, because of the "revving-up" of the immune system. Flu-like syndrome occurs hours to days after the infusion and is characterized by fever, chills, weakness, muscle and joint aches. Medications such as acetaminophen can be used to manage these symptoms. Try to keep warm with blankets and warm clothes and drink plenty of non-alcoholic fluids. These symptoms tend to lessen over time on low-dose regimens.
Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods that absorbs fluid and can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange and grapefruit sections, boiled potatoes, white rice and products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration. Read Low Fiber Diet for Diarrhea for more tips.
Rash with or without itching may occur. Antihistamines (like diphenhydramine) or topical steroids can be used to control symptoms, if needed. It is important to prevent scratching and breaking of the skin, given the risk for skin infections with lowered white blood cell counts on this therapy. Oatmeal baths can be used to help with dry, itchy skin. Use an alcohol-free moisturizer on your skin and lips, avoiding moisturizers with perfumes or scents. If your skin does crack or bleed, be sure to keep the area clean to avoid infection. For more suggestions, read the Nail and Skin Care Tip Sheet.
Low White Blood Cell Count (Leukopenia or Neutropenia)
White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4 F), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.
Tips to preventing infection:
- Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
- Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
- When working in your yard, wear protective clothing including long pants and gloves.
- Do not handle pet waste.
- Keep all cuts or scratches clean.
- Shower or bath daily and perform frequent mouth care.
- Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
- Ask your doctor or nurse before scheduling dental appointments or procedures.
- Ask your doctor or nurse before you, or someone you live with, has any vaccinations.
For more suggestions, read the Neutropenia Tip Sheet.
Low Red Blood Cell Count (Anemia)
Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your doctor or nurse know if you experience any shortness of breath, difficulty breathing or pain in your chest. If the count gets too low, you may receive a blood transfusion. Read the anemia tip sheet for more information.
Low Platelet Count (Thrombocytopenia)
Platelets help your blood clot, so when the count is low you are at a higher risk of bleeding. Let your doctor or nurse know if you have any excess bruising or bleeding, including nosebleeds, bleeding gums or blood in your urine or stool. If the count becomes too low, you may receive a transfusion of platelets.
- Do not use a razor (an electric razor is fine).
- Avoid contact sports and activities that can result in injury or bleeding.
- Do not take aspirin (salicylic acid), non-steroidal, anti-inflammatory medications (NSAIDs) such as Motrin®, Aleve®, Advil®, etc. as these can all increase the risk of bleeding. You may take acetaminophen (Tylenol).
- Do not floss or use toothpicks and use a soft-bristle toothbrush to brush your teeth.
Read the thrombocytopenia tip sheet for more information.
Nausea and/or Vomiting
Take anti-nausea medications as prescribed. If you continue to have nausea or vomiting, notify your doctor or nurse so they can help you manage this side effect. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms. Read the Nausea & Vomiting Tip Sheet for more suggestions.
Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.
While on cancer treatment you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team and see OncoLink's section on fatigue for helpful tips on dealing with this side effect.
Decrease in Appetite
- Try to eat five or six small meals or snacks throughout the day, instead of 3 larger meals.
- If you are not eating enough, nutritional supplements may help.
- You may experience a metallic taste or dislike foods or beverages that you liked before receiving chemotherapy. These symptoms can last up to several months.
- Avoid any food that you think smells or tastes bad. If red meat is a problem, eat chicken, turkey, eggs, dairy products and fish without a strong smell.
- Flavor meat or fish by marinating it in sweet juices, sweet and sour sauce or dressings. Use seasonings like basil, oregano or rosemary. Bacon, ham and onion can also add flavor to vegetables.
Capillary Leak Syndrome
Capillary leak syndrome is a potentially serious complication in which fluids from the veins and capillaries leak into the tissue outside the bloodstream. This results in low blood pressure and poor blood flow to the internal organs. Capillary leak syndrome is characterized by the presence of 2 or more of the following 3 symptoms: low blood pressure, swelling, and low levels of protein in the blood (hypoalbuminemia). Your doctor will monitor these levels while you are taking interleukin-2. You should notify your doctor immediately if you notice dizziness (especially when changing position), sudden swelling or rapid weight gain, little or no urine output (for 8-12 hours), shortness of breath, difficulty breathing, irregular heart beats, or chest pain. This syndrome generally occurs within about 2 weeks of treatment.