Intrathecal IL2 for melanoma patients with leptomeningeal disease - long-term efficacy!!!

Long-term efficacy of intrathecal interleukin-2 (IT IL2) in metastatic melanoma patient with leptomeningeal disease (LMD).  Glitza, Rohlfs, Basset, et al.  Abstract 517. Immunotherapy and Cancer.  September 2015.

Melanoma patients with LMD have an extremely poor prognosis. Here, we present long-term follow-up data for patients with LMD treated with IT IL2 at MD Anderson....  Diagnosis of LMD was based on CSF cytology and/or radiographic findings on MRI.  IL2 was administered through an Ommaya reservoir.  Pts received 1-5 doses/wk of IT IL2.... followed by single doses every 1-3 months as maintenance.  [Statistical analysis revealed....]

Among 42 patients, 3 patients had positive CSF cytology only, 11 had radiographic findings only, and 28 had both.  Symptoms due to increased ICP [intracranial pressure] developed in all pts during induction phase, including headache, nausea, and were controlled with supportive meds and/or CSF removal.  Median OS = 9.1 months, 16% of patients had OS greater than 24 months.  Patients with LMD only without extracranial (ECD) disease had median OS of 38.4 months from the start of IT IL2.  Pts with ECD that was was controlled (OS = 11 months) survived longer than pts with uncontrolled ECD (6.5 months), although the difference was not statistically significant.  Previous or concurrent parenchymal brain mets had no impact on OS.  Shorter OS was associated with the presence of neurological signs at baseline and positive CSF cytology.  OS was not significantly associated with age, gender, LDH, or BRAF mutation status.

Conclusion:  ....results provide evidence that IT immunotherapy can benefit select patients with LMD.

Still a sucky situation for too many, but at least this provides some proof of benefit for intrathecal administration of IL2 for leptomeningeal disease.  Just wish 'long-term efficacy' was a bit longer!!!!  Hopefully, this is only a start!! - c