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

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 therapy

• 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 every 12 hours
• Ranitidine (Zantac) 150 mg PO twice per day
• Lorazepam (Ativan) 1 to 2 mg IV or PO 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 IV or PO every 6 hours prn pruritis
• Prochlorperazine (Compazine) 10 mg IV or PO every 6 hours prn nausea/vomiting
• Cephalexin (Keflex) 500 mg PO twice per day
• 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 IV or PO 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 less than 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 less than 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 less than 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 less than 1.5, call NP/MD
• Hydrocerin (Eucerin) apply topically QID prn dry skin
• Sarna lotion apply topically QID prn pruritis
• Gelclair 15 mL PO three times per day prn mucositis
• Maalox/Diphenhydramine/Lidocaine 5 mL PO four times per day prn mucositis
• Ondansetron (Zofran) 8 mg PO/NG every 8 hours prn nausea
• Loperamide (Imodium) 2 mg PO four times per day 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 less than 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 less than 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