is an immunostimulatory cytokine with antitumor activity in preclinical animal models. A phase I study of recombinant human IL-18 (rhIL-18) was done to determine the toxicity, pharmacokinetics, and biological activities of rhIL-18 in patients with advanced cancer. Experimental Design: Cohorts of patients were given escalating doses of rhIL-18, each administered as a 2-hour i.v. infusion on 5 consecutive days. Toxicities were graded using standard criteria. Serial blood samples were obtained for pharmacokinetic and pharmacodynamic measurements. Results: Twenty-eight patients (21with renal cell cancer, 6 with melanoma, and 1with Hodgkin's lymphoma) were given rhIL-18 in doses ranging from 3 to 1,000 Ag/kg. Common side effects included chills, fever, nausea, headache, and hypotension. Common laboratory abnormalities included transient, asymptomatic grade 1to 2 neutropenia, thrombocytopenia, anemia, hypoalbuminemia, hyponatremia, and elevations in liver transaminases. One patient in the100 Ag/kg cohort experienced transient grade 3 hypotension and grade 2 bradycardia during the first infusion of rhIL-18. No other dose-limiting toxicities were observed. Plasma concentrations of rhIL-18 increased with increasing dose, and 2.5-fold accumulation was observed with repeated dosing. Biological effects of rhIL-18 included transient lymphopenia and increased expression of activation antigens onlymphocytes and monocytes. Increases in serum concentrations of IFN-g, granulocyte macrophage colony-stimulating factor, IL-18 bindingprotein, and soluble Fasligand were observed. Two patients experiencedunconfirmed partial responses after rhIL-18 treatment. Conclusions: rhIL-18 can be safely given in biologically active doses to patients with advanced cancer. A maximum tolerated dose of rhIL-18 was not determined. Further clinical studies of rhIL-18 are warranted.
Interleukin (IL)-18 is an immunostimulatory cytokine thatregulates both innate and adaptive immune responses (1, 2). The effects of IL-18 are mediated through a specific cell surface receptor complex composed of at least two subunits, an a chain (IL-1Rrp1) and a h chain (AcPL; ref. IL-18 has antitumor activity in animal models (8 -12). Regression of tumors in IL-18-treated animals is not dependent on the presence of IFN-g or IL-12 but seems to require an intact Fas/Fas ligand pathway (9, 10). The antitumor effects of IL-18 in multiple animal models provided the rationale for investigation of recombinant human (rh) IL-18 in cancer immunotherapy. We describe the results of the first clinical trial of rhIL-18 in patients with cancer.
Materials and MethodsPatient selection. Eligible patients included adults (ages >18 years) with histologically confirmed, locally advanced, or metastatic solid tumor or lymphoma that was measurable and refractory to standard