High dose Interleukin 2 (HD IL2) as 1st line treatment in metastatic renal cell carcinoma (mRCC): A 10-year single centre experience.

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4555 Background: Targeted therapy has become the treatment of choice for majority of mRCC cases in recently. For most, treatment benefit is short-lived and given with palliative intent. HD IL2 is an effective treatment capable of durable remission but its unselected use was difficult due to modest response rate and considerable toxicity. Using a set pathology criteria as selection tool, we have been able to show improved outcomes in our previous report (Shablak et al 2011) . We present a 10-yr experience in our centre. Methods: Prospective pathology selection began in 2006. Tumour specimens were reviewed and stratified into Favourable or Other categories based on constitution of histology growth patterns. HD IL2 was preferentially offered to Favourable category. Outcome evaluation included response rates, survival, and treatment tolerance. Multivariate analysis were performed to explore potential prognostic and predictive factors. Results: Total patients reviewed were 145 (2003 – 2013). Among prospective cohort with Favourable pathology n = 106, overall response rate was 48.1% with CR rate of 21.6%. Median OS was 49.4 months. Factors linked to significantly better response and/or survival include > 50% alveolar growth pattern, higher cycle 1 tolerance ( > 18 doses), < 3 metastatic organ sites , and > 6/12 duration between diagnosis and start of treatment. CAIX (Carbonic anhydrase 9) is prognostic but not predictive of response. Toxicities were those expected of IL2 but was manageable on general medical wards, with no treatment-related death. Importantly most CRs were durable with 76% (23/30) remained relapse-free (median 39 months follow up). Conclusions: Our experience shows that HD IL2 remains an effective and safe treatment in well-selected cases of mRCC. Results from this large prospective series confirms similar outcomes to our previously reported retrospective series. Given the prospect of long-term remission, fit patients with Favourable histology and low disease burden should be considered for HD IL2 in experienced centre. Better understanding has been gained from this in-depth analysis especially that of possible predictors and strategies likely improve treatment outcome.

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