Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Cancer
Published in: BMC Cancer 1/2018

Open Access 01-12-2018 | Research article

Rigor prophylaxis in stage IV melanoma and renal cell carcinoma patients treated with high dose IL-2

Authors: Brian Khong, Benjamin O. Lawson, Junjie Ma, Cheryl McGovern, Joan K. Van Atta, Abhijit Ray, Hung T. Khong

Published in: BMC Cancer | Issue 1/2018

Login to get access

Abstract

Background

Rigors are a significant adverse event during interleukin-2 (IL2) therapy for metastatic melanoma and renal cell carcinoma. Meperidine has been a mainstay for rigor prophylaxis but there is a paucity of data regarding possible alternatives.

Methods

Ninety one patients receiving IL2 therapy for metastatic renal cell carcinoma and melanoma at Huntsman Cancer institute (HCI), Utah from May 2009 to October 2016 were retrospectively evaluated for rigor prophylaxis. Forty two patients received meperidine and 49 received tramadol. Rigors were tabulated using the proxy of number of doses of as needed (PRN) rigor medications and normalized by IL2 doses. Other outcomes of fever, hypotension, and renal insufficiency were noted on a binary scale and normalized by cycles. Statistical analysis was performed utilizing univariate and multivariate negative binomial models.

Results

Ninety one patients were identified with metastatic melanoma or RCC who received high dose IL2 therapy. Forty two received meperidine and 49 received tramadol prophylaxis for rigors. Univariate negative binomial analysis shows incidence rate ratios (IRR): fever 0.41 (95% CI 0.28–0.62, p-value < 0.001), hypotension 1.7 (95% CI 1.11–2.61, p-value 0.015), renal insufficiency 0.58 (95% CI 0.35–0.98, p-value 0.041), rigors per all PRN meds 1.01 (95% CI 0.79–1.28, p-value 0.964), and rigors via opioid PRN meds 0.85 (95% CI 0.67–1.07, p-value 0.168). Multivariate negative binomial analysis shows IRR: fever 0.59 (95% CI 0.28–1.24, p-value 0.163), hypotension 0.93 (95% CI 0.43–2.03, p-value 0.864), renal insufficiency 1.1 (95% CI 0.52–2.32, p-value 0.807), rigors per al PRN meds 0.92 (95% CI 0.67–1.26, p-value 0.604), and rigors via opioid PRN 0.9 (95% CI 0.65–1.26, p-value 0.554).

Conclusion

Univariate models indicated meperidine pre-treatment was associated with significantly lower rates of fever and renal insufficiency whereas tramadol was associated with significantly lower rate of hypotension. However, when controlled for demographics and other treatment differences, these differences were no longer significant.
Literature
1.
2.
3.
4.
Schwartz RN, Stover L, Dutcher J. Managing toxicities of high-dose interleukin-2. Interventions (table 3). Oncology. 2002;13:14.
5.
Sparano JA, Fisher RI, Sunderland M, Margolin K, Ernest ML, Sznol M, Atkins MB, Dutcher JP, Micetich KC, Weiss GR. Randomized phase III trial of treatment with high-dose interleukin-2 either alone or in combination with interferon alfa-2a in patients with advanced melanoma. J of Clin Onc. 1993;11(10):1969–77.CrossRef
6.
Atkins MB, Lotze MT, Dutcher JP, Fisher RI, Weiss G, Margolin K, Abrams J, Sznol M, Parkinson D, Hawkins M, Paradise C. High-dose recombinant interleukin 2 therapy for patients with metastatic melanoma: analysis of 270 patients treated between 1985 and 1993. J of Clin Onc. 1999;17(7):2105.CrossRef
7.
Fyfe G, Fisher RI, Rosenberg SA, Sznol M, Parkinson DR, Louie AC. Results of treatment of 255 patients with metastatic renal cell carcinoma who received high-dose recombinant interleukin-2 therapy. J of Clin Onc. 1995;13(3):688–96.CrossRef
8.
Kammula US, White DE, Rosenberg SA. Trends in the safety of high dose bolus interleukin-2 administration in patients with metastatic cancer. Cancer. 1998;83(4):797–805.CrossRef
9.
Schwartzentruber DJ. Interleukin-2: Clinical applications. Principles of administration and management of side effects. Principles and practice of the biologic therapy of Cancer. Philadelphia, PA: Lippin Wil & Wil. 2000:32–50.
10.
Dutcher J, Atkins MB, Margolin K, Weiss G, Clark J, Sosman J, Logan T, Aronson F, Mier J. Cytokine working group. Kidney cancer: the cytokine working group experience (1986–2001). Med Onc. 2001;18(3):209–19.CrossRef
11.
Dutcher JP, Schwartzentruber DJ, Kaufman HL, Agarwala SS, Tarhini AA, Lowder JN, Atkins MB. High dose interleukin-2 (Aldesleukin)-expert consensus on best management practices-2014. J for ImmunoTherapy of Cancer. 2014;2(1):26.CrossRef
12.
Park SM, Mangat HS, Berger K, Rosengart AJ. Efficacy spectrum of antishivering medications: meta-analysis of randomized controlled trials. Crit Care Med. 2012;40(11):3070–82.CrossRef
13.
Dhimar AA, Patel MG, Swadia VN. Tramadol for control of shivering (comparison with pethidine). Indian J of Anes. 2007;51(1):28.
14.
Burks LC, Aisner J, Fortner CL, Wiernik PH. Meperidine for the treatment of shaking chills and fever. Archiv of int med. 1980;140(4):483–4.CrossRef
15.
Bhatnagar S, Saxena A, Kannan TR, Punj J. Tramadol for postoperative shivering: a double-blind comparison with pethidine. Anes and int care. 2001;29(2):149.
16.
Mohta M, Kumari N, Tyagi A, Sethi AK, Agarwal D, Singh M. Tramadol for prevention of postanaesthetic shivering: a randomised double-blind comparison with pethidine. Anes. 2009;64(2):141–6.CrossRef
17.
Witte J, Deloof T, Veylder J, Housmans PR. Tramadol in the treatment of postanesthetic shivering. Acta Anaesthesiol Scand. 1997;41(4):506–10.CrossRef
18.
Tsai YC, Chu KS. A comparison of tramadol, amitriptyline, and meperidine for postepidural anesthetic shivering in parturients. Anesth Analg. 2001;93(5):1288–92.CrossRef
Metadata
Title
Rigor prophylaxis in stage IV melanoma and renal cell carcinoma patients treated with high dose IL-2
Authors
Brian Khong
Benjamin O. Lawson
Junjie Ma
Cheryl McGovern
Joan K. Van Atta
Abhijit Ray
Hung T. Khong
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2018
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-018-4810-y

Other articles of this Issue 1/2018

BMC Cancer 1/2018 Go to the issue

Correction

Correction to: Metabolomic profiling identifies distinct phenotypes for ASS1 positive and negative GBM

Research article

Inhibition of p38 MAPK activity leads to cell type-specific effects on the molecular circadian clock and time-dependent reduction of glioma cell invasiveness

Research article

Symptomatic venous thromboembolism associated with peripherally inserted central catheters predicts a worse survival in nasopharyngeal carcinoma: results of a large cohort, propensity score–matched analysis

Research article

Targeted next generation sequencing identified clinically actionable mutations in patients with esophageal sarcomatoid carcinoma

Research article

Normalization of abnormal plasma amino acid profile-based indexes in patients with gynecological malignant tumors after curative treatment

Case report

Primary cardiac myxofibrosarcoma: case report, literature review and pooled analysis
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits