Cytokines

October 24, 2024

This page was reviewed under our medical and editorial policy by Alexis Boling, MSN-RN, CNML, director, nursing, Immune Effector Cell & Gene Therapy Program, City of Hope^® Cancer Center Duarte

Immunotherapy is a type of cancer treatment that uses the body’s own immune response to target cancer cells. There are many types of immunotherapy, but cytokines were the first kind approved by the U.S. Food and Drug Administration (FDA).

Today, newer immunotherapies are more often used. Still, cytokines remain an important cancer treatment option for some patients. A cancer care team may recommend cytokine treatment alone, alongside chemotherapy or in combination with another immunotherapy medication.

Many factors are considered when choosing a cancer treatment. The specific type of cancer, its stage and how a patient’s cancer responded to past treatments will be considered, as well as the patient’s preferences and goals. The care team may also order pre-treatment tests to assess how well the patient might tolerate cytokine treatment.

What Are Cytokines?

Cytokines are immune proteins in the body.

Many types of cells produce cytokines. As a group, cytokines send messages between immune-related cells that regulate growth and cellular replication. They also play an important role in the development and progression of cancer.

What Do Cytokines Do?

Different cytokines have different roles. Some stimulate the immune system and may slow cancer growth. Others slow the immune system, making it easier for cancer to grow.

Medication forms of cytokines used in cancer treatment mimic the effects of the immune-enhancing cytokines naturally produced by the body.

This type of immunotherapy medicine may work to treat cancer in several ways:

• Slowing cancer cell growth by making it harder for them to divide
• Activating anti-tumor immune cells like killer T cells
• Helping the immune system find cancer cells so they may be targeted

Types of Cytokines

Cytokine medications are lab-made versions of a specific cytokine type made in the body. Three types of cytokines are FDA-approved as medications:

• Growth factors
• Interleukins
• Interferons

Growth factors are commonly used to manage low blood counts caused by cancer treatment. Interleukins and interferons are used to treat cancer. Both work similarly but have some different uses. They are also administered and dosed differently.

Many other cytokines have been studied in treating cancer, including some with promising results. Researchers are still investigating how they might be used in cancer treatment regimens. They are also studying how well approved cytokines might treat cancer in different dosing regimens and combinations.

Interleukins

Proleukin^® (aldesleukin) is a lab-made version of a natural cytokine called interleukin-2 (IL-2). In the body, IL-2 is released by a type of white blood cell known as T cells. Then, IL-2 stimulates other immune cells to help fight infection or cancer.

Aldesleukin is approved for treatment of advanced forms of melanoma and kidney cancer that have spread to other parts of the body. A health care team may also recommend IL-2 treatment for another form of cancer based on results from early clinical trials.

Aldesleukin is usually administered as a high-dose intravenous (IV) infusion. Due to the risk of infusion-related reactions, infusions are given in an inpatient hospital setting where patients may be closely monitored and quickly treated if a severe reaction occurs.

Each treatment typically includes three doses a day for five days. Then the patient has a nine-day rest period followed by another five-day infusion cycle. Based on the patient’s response, a second treatment course may be recommended. Typically, a seven-week rest period is needed between the end of the first course and the start of the second.

Interferons

INTRON^® A (interferon alfa-2b) is a medication that works like the body’s own interferon alfa (IFN-alfa), a natural chemical in the body that helps the immune system target cancer cells. It also slows cancer growth and limits blood supply to cancers in the body.

Like aldesleukin, interferon alfa-2b is also FDA-approved to treat melanoma and kidney cancer. However, it is less commonly used for melanoma today due to the availability of newer treatment options. For kidney cancer, interferon alfa-2b may be used alone or in combination with another immunotherapy medication called Avastin^® (bevacizumab). Interferon alfa-2b is also used to treat some blood cancers, as well as cutaneous (skin) T cell lymphoma.

Interferon alfa-2b is given as an injection, but how it is administered depends on the cancer being treated. Most often, it is given as an injection just under the skin three times a week.

While interferon alfa-2b has had a lack of availability in the United States due to manufacturer decisions, the care team will help provide guidance regarding availability or other immunotherapy options.

Besremi^® (ropeginterferon alfa-2b-njft) is a newer interferon medication approved to treat a type of blood cancer. PEGASYS^® (peginterferon alfa-2a) is another type of interferon medication that is being studied to treat T cell lymphoma.

Side Effects of Cytokines

A range of side effects may occur during cytokine treatment. The care team will consider a patient’s individual risk for side effects prior to starting treatment. During treatment, they may recommend lower dosages, fewer treatments or a change in treatment based on how well cytokines are tolerated by the patient.

Supportive medications may help prevent or manage some side effects. Common side effects from cytokine cancer treatment may include:

• Low blood cell counts
• Increased risk of infection
• Flu-like symptoms, including chills and fever
• Nausea and vomiting
• Fatigue
• Skin rashes (interferon alfa-2b)
• Hair thinning (interferon alfa-2b)

More serious but rare side effects are also possible, including:

• Long-term nerve damage
• New or worsening autoimmune disease
• Serious allergic reaction
• Change or loss in vision
• Kidney damage (aldesleukin)
• Serious infections

Additional side effects with IL-2 treatment are possible.

Aldesleukin is typically administered in a hospital setting so patients may be closely monitored before, during and after infusions. Additional side effects may occur with aldesleukin treatment, including:

• Capillary leak syndrome (severely low blood pressure)
• Serious heart events

The care team may recommend medications before treatment to help prevent side effects. Additional medications and/or treatments may be recommended to help manage side effects if they occur.

Cytokine Research at City of Hope

Researchers at City of Hope are at the forefront of research and innovations involving cytokines. Our scientists are constantly evaluating new options and improving the efficacy of existing cytokine therapies to create more powerful cancer treatments.

Learn more about our cytokines research