Example orders for High-dose (HD) IL-2 in melanoma

Carboplatin & Paclitaxel (CP)

CP: Carboplatin & Paclitaxel

Regimen

Study	Dates of enrollment	Evidence	Comparator	Comparative Efficacy
Forde et al. 2022 (CheckMate 816)	2017-2019	Phase 3 (C)	1a. CP & Nivolumab 1b. CVb & Nivolumab 1c. DC & Nivolumab	Inferior EFS

Note: there were additional comparator options depending on histology; see the respective histology-specific pages for more details. This study was conducted in the United States. The reason for the study was that an unanswered question at the time was whether adding an immune checkpoint inhibitor would improve outcomes.

Biomarker eligibility criteria

• CheckMate 816: No sensitizing EGFR or ALK mutations

Chemotherapy

• Carboplatin (Paraplatin) AUC 5 or 6 IV once on day 1
• Paclitaxel (Taxol) 175 or 200 mg/m² IV once on day 1

21-day cycle for 3 cycles

Subsequent treatment

• Complete resection

References

1. CheckMate 816: Forde PM, Spicer J, Lu S, Provencio M, Mitsudomi T, Awad MM, Felip E, Broderick SR, Brahmer JR, Swanson SJ, Kerr K, Wang C, Ciuleanu TE, Saylors GB, Tanaka F, Ito H, Chen KN, Liberman M, Vokes EE, Taube JM, Dorange C, Cai J, Fiore J, Jarkowski A, Balli D, Sausen M, Pandya D, Calvet CY, Girard N; CheckMate 816 Investigators. Neoadjuvant Nivolumab plus Chemotherapy in Resectable Lung Cancer. N Engl J Med. 2022 May 26;386(21):1973-1985. Epub 2022 Apr 11. link to original article contains dosing details in manuscript PubMed NCT02998528

Start of hidden/commented information for virtual editor End of hidden/commented information for virtual editor

Start of comment inserted by visual editor(edited again by visual editor)

(edited again by visual editor end)End of comment inserted by visual editor
Use of this site is subject to you reading and agreeing with the terms set forth in the disclaimer. If this is your first time visiting, we suggest you read the tutorial.

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.

High-dose (HD) IL-2

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

Example order set #1

• IL-2 - Aldesleukin (Proleukin) 600,000 units/kg IV every 8 hours (at 00:00, 08:00, 16:00) x up to 14 doses per week, on days 1 to 5
  • After a 6 to 9 day rest period, another 14 doses per week given over 5 days is given as described above

6 to 12 weeks per cycle x up to 5 cycles

Supportive medications

• Acetaminophen (Tylenol) 975 mg PO Q6H, 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

• Dopamine 4 mcg/kg/min IV drip, titrate to keep SBP at least 80, prn hypotension refractory to fluid boluses. Cardiac monitor while on medication.
• Phenylephrine 1 mcg/kg/min IV drip, titrate to keep SBP at least 80, prn if target SBP not met while patient is on on maximum dopamine dose. Cardiac monitor while on medication.
• 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
• For hypotension: 250 ml NS bolus over 15 minutes prn SBP <90, may repeat X2 (total 3 boluses). This order to be discontinued for weight gain >5% of baseline.
• 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