Example orders for IL-2 maintenance biotherapy in melanoma

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Remember that example order sets that may contain additional information about supportive medications, suggestions for monitoring, hydration, and pre-treatment screening information for chemotherapy regimens are purely anecdotal, provided only as examples of what some other providers may be using, and are typically not based on references in the primary literature.

IL-2 maintenance biotherapy

Published regimens and references can be found on the melanoma page.

Example order set #1

Low-dose cycles 1, 4, 7, 9, 11

Done as an outpatient.

• IL-2 - Aldesleukin (Proleukin) 1,000,000 units/m² SC once per day every Monday to Friday on days 1 to 28

28-day cycles x a total of 12 cycles after being combined with the pulse cycles below

Supportive medications

• Sargramostim (Leukine) 125 mcg/m² SC once per day on days 1 to 14
• Can use the pulse cycle inpatient medications below on a prn basis

Pulse cycles 2, 3, 5, 6, 8, 10, 12

Days 1 & 2 are done as an inpatient.

• IL-2 - Aldesleukin (Proleukin) 18,000,000 units/m² IV over 6 hours; then IL-2 - Aldesleukin (Proleukin) 18,000,000 units/m² IV over 12 hours; then IL-2 - Aldesleukin (Proleukin) 18,000,000 units/m² IV over 24 hours; these three doses are given consecutively on days 1 to 2
• As an outpatient: IL-2 - Aldesleukin (Proleukin) 1,000,000 units/m² SC once per day every Monday to Friday on days 3 to 28

28-day cycles x a total of 12 cycles after being combined with the low dose cycles above

Supportive medications as an outpatient:

• Sargramostim (Leukine) 125 mcg/m² SC once per day on days 3 to 16
• Can use the inpatient medications below on a prn basis

Supportive medications as an inpatient:

• Acetaminophen (Tylenol) 975 mg PO Q6H on days 1 & 2, to begin prior to IL-2. Total acetaminophen dosage not to exceed 3900 mg/day
• Naproxen 375 mg PO Q12H
• Ranitidine (Zantac) 150 mg PO BID
• Lorazepam (Ativan) 1 to 2 mg PO/IV Q4H prn nausea/vomiting
• Meperidine (Demerol) 25 to 50 mg in 50 mL D5W IV over 15 minutes Q2H prn severe chills/rigors
• Diphenhydramine (Benadryl) 25 to 50 mg PO/IV Q6H prn pruritis
• Prochlorperazine (Compazine) 10 mg PO/IV Q6H prn nausea/vomiting
• Cephalexin (Keflex) 500 mg PO BID
• Diphenoxylate-Atropine (Lomotil) 1 to 2 tabs PO prn each loose stool, maximum of 8 tabs per day
• Potassium chloride PO/IV sliding scale repletion; for K 3.8 to 3.6: 40 mEq; for K 3.5 to 3.3: 60 mEq; for K 3.2 to 3.0: 80 mEq; for K <3.0: contact NP/MD
• Calcium gluconate IV sliding scale repletion; for corrected Ca 7.5 to 7.1: 2 g IV; for corrected Ca <7: 3 g and contact NP/MD
• Magnesium sulfate IV sliding scale repletion; for Mg 1.6 to 2: 2 g IV; for Mg 1.2 to 1.5: 2 to 4 g IV; for Mg <1.2: 4 g IV and call NP/MD
• Potassium phosphate 15 mmol in 250 mL NS IV over 5 hours prn serum phosphate 1.5 to 2.3; if serum phosphate <1.5, call NP/MD
• Hydrocerin (Eucerin) apply topically QID prn dry skin
• Sarna lotion apply topically QID prn pruritis
• Gelclair 15 mL PO TID prn mucositis
• Maalox/Diphenhydramine/Lidocaine 5 mL PO QID prn mucositis
• Ondansetron (Zofran) 8 mg PO/NG Q8H prn nausea
• Loperamide (Imodium) 2 mg PO QID prn diarrhea

Hydration:

• Standing IV fluids: 1 liter NS, continuous at 75 mL/H
• Sodium bicarbonate-containing fluids to be used as follows:
  • If serum bicarbonate is 18 to 19, change IV fluids to 1 liter D5 1/2 NS with 50 mEq sodium bicarbonate, continuous at 75 mL/H. Once bicarbonate is at least 20, resume standing IV fluids above.
  • If serum bicarbonate is 16 to 17, administer 100 mL D5W with 100 mEq sodium bicarbonate over 1 hour and hold IL-2.
  • If bicarbonate is <16, give 100 mEq sodium bicarbonate as above and contact NP/MD and recheck bicarbonate 1 hour after infusion.

Monitoring:

• Check daily CBC with differential, comprehensive metabolic panel including sodium, potassium, chloride, bicarbonate, BUN, creatinine, glucose, calcium, magnesium, phosphate, alkaline phosphatase, AST, ALT, total bilirubin; once every 2 day monitoring of PT/PTT