Denileukin Diftitox in Treating Patients With Metastatic Melanoma or Metastatic Kidney Cancer

Phase II Evaluation of Denileukin Diftitox in Patients With Metastatic Melanoma or Metastatic Kidney Cancer

RATIONALE: Denileukin diftitox may be able to make the body build an immune response to kill tumor cells.

PURPOSE: This phase II trial is studying how well denileukin diftitox works in treating patients with metastatic melanoma or metastatic kidney cancer.

OBJECTIVES:

Primary

• Determine the clinical response in patients with metastatic melanoma or metastatic kidney cancer treated with denileukin diftitox.

Secondary

• Determine whether changes occur in levels of CD4-positive CD25-positive lymphocytes in the peripheral blood of these patients before and after treatment with this drug.
• Determine the toxicity profile of this drug in these patients.

OUTLINE: Patients are stratified according to disease type (metastatic melanoma vs metastatic kidney cancer).

Patients receive denileukin diftitox IV over 1 hour on days 1-5, 21-25, 42-46, and 63-67. Treatment repeats every 84 days (12 weeks) for up to a maximum total of 5 courses in the absence of disease progression, autoimmune ocular toxicity attributable to denileukin diftitox, or any other unacceptable toxicity. At any time during therapy, patients achieving a complete response receive 1 additional course of therapy after the complete response.

PROJECTED ACCRUAL: A total of 10-96 patients (5-48 per stratum) will be accrued for this study within 3-4 years.

DISEASE CHARACTERISTICS:

• Diagnosis of 1 of the following:

  • Melanoma
  • Kidney cancer

• Metastatic disease

• Measurable disease

• Documented disease progression while receiving standard therapy

• No resectable local or regional disease

PATIENT CHARACTERISTICS:

Age

• 16 and over

Performance status

• ECOG 0-2

Life expectancy

• More than 3 months

Hematopoietic

• WBC ≥ 3,000/mm^3
• Platelet count ≥ 90,000/mm^3
• Lymphocyte count ≥ 500/mm^3
• No concurrent coagulation disorders

Hepatic

• Bilirubin ≤ 2.0 mg/dL (< 3.0 mg/dL for patients with Gilbert's syndrome)
• AST and ALT < 3 times normal
• Albumin ≥ 2.5 g/dL
• Hepatitis B surface antigen negative
• Hepatitis C antibody negative

Renal

• Creatinine ≤ 2.0 mg/dL

Cardiovascular

• Normal thallium stress test*
• No prior myocardial infarction
• No history of severe coronary artery disease
• No major medical illness of the cardiovascular system NOTE: *For patients > 50 years of age OR who have a history of cardiovascular disease

Pulmonary

• No major medical illness of the respiratory system

Immunologic

• HIV negative
• No active systemic infection
• No presence of opportunistic infections
• No primary or secondary immunodeficiency
• No autoimmune disease
• No other known immunodeficiency

Other

• No sensitivity to denileukin diftitox or any of its components (e.g., diphtheria toxin, interleukin-2, or excipients)
• Willing to undergo leukapheresis
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

Biologic therapy

• Prior treatment with interleukin-2 allowed provided the patient's disease status required this therapy

Chemotherapy

• Recovered from prior chemotherapy

Endocrine therapy

• No concurrent systemic steroids

Radiotherapy

• Recovered from prior radiotherapy

Surgery

• Not specified

Other

• More than 3 weeks since prior systemic anticancer therapy
• No other concurrent systemic anticancer therapy