Your white blood cells make cytokines to communicate with other immune cells. Cytokines stimulate inflammation and a response from your immune system. Taking high doses of cytokines as medication gives your immune system a boost to fight cancer.1 Two cytokines used to treat skin cancer are:
- Interferon, which comes in two forms: interferon-alfa and peginterferon
What do cytokines treat?
Cytokines can be used as a primary treatment or adjuvant treatment for skin cancer.2 They can be used alone or as part of a combination treatment approach called biochemotherapy. Primary treatment is the main treatment administered for cancer. It is usually chosen based upon the stage and type of cancer, other genetic factors for the individual patient, and is considered in relation to other treatment options available. Adjuvant therapy is an additional cancer treatment that is given after the primary treatment. Adjuvant therapy can help lower the risk that the cancer comes back. Biochemotherapy may include the combination of interleukin-2, interferon, and chemotherapy.
IL-2 is a cytokine that activates your immune system. Your body makes IL-2 naturally in small amounts. Taking larger amounts of IL-2 as medication gives your immune system a boost. IL-2 tells your body to make more T-cells and Natural Killer cells.2,3 T-cells (T-lymphocytes) and Natural Killer cells are white blood cells. They fight cancer and infection. IL-2 makes T-cells better at killing cancer cells. IL-2 also increases production of interferon, another immune system booster.
Interferon-alfa is a cytokine that activates your immune system. Your body makes interferon naturally in small amounts. Taking larger amounts of interferon-alfa as medication gives your immune system a boost. Interferon is a signaling molecule. It does not attack cancer cells directly. Instead, it binds (connects) to a receptor on the surface of a cell and sets off a chain of events inside the cell.
Peginterferon alfa-2b is a cytokine that is made in a lab and taken as a medication. Peginterferon alfa-2b is also called by the brand name Sylatron™. It is made by combining man-made interferon-alfa with a chemical called polyethylene glycol (abbreviated PEG).1 Adding PEG keeps the interferon-alfa in your body longer. The result is that peginterferon can be given less frequently than interferon-alfa.3
Cytokine therapy for high-risk stage II melanoma. In stage II melanoma, the cancer has not spread beyond the skin tumor. However, thick skin tumors are considered at high-risk for recurrence. Interferon-alfa may be used as adjuvant treatment for thick stage II melanoma.2
Cytokine therapy stage III melanoma. In stage III melanoma, the cancer has spread to the lymph nodes. Options for adjuvant treatment for stage III cancer include interferon-alfa, peginterferon, or biochemotherapy. Satellite or in-transit tumors are tumors found near the main tumor. They may be treated by injecting interleukin-2 or interferon directly into them.2
Cytokine therapy for stage IV (metastatic) melanoma. Metastatic melanoma is when the cancer has spread to distant parts of the body. High-dose interleukin-2 or biochemotherapy may be options to treat metastatic melanoma. It is usually used if other treatments are not working.2
Cytokine therapy for Kaposi sarcoma. Interferon-alfa is used to treat some patients with Kaposi sarcoma. It works best for patients with no systemic symptoms, limited lymph node disease, and fairly good immune function.
How are cytokines taken?
Cytokine medications may be injected into a vein (intravenously), below the skin (subcutaneously), or into the tumor (intralesionally). Depending on the treatment, cytokines may be taken daily, several times per week, or once weekly.
High-dose interleukin-2 must be given in the hospital. Low-dose interleukin-2, maintenance interferon-alfa, and peginterferon are shots that may be given in the doctor’s office, in an infusion center, or possibly self-administered at home.
What are side effects of cytokines?
Cytokines stir up the whole immune system. This can lead to significant and severe side effects throughout your body. Careful monitoring is needed.
People typically experience flu-like symptoms while taking cytokines. Other possible side effects include:1
- Severe allergic reaction
- Low blood cell counts, leading to risk of infection or bleeding
- Damage to the heart, lungs, kidneys, liver, or brain
- Changes in mental health
How are cytokines different from targeted immunotherapies?
Cytokines are general immune system boosters. They rally your immune system’s defenses to fight cancer cells.
Targeted immunotherapies act on specific proteins on particular cells. They change the way that immune cells interact with cancer cells. They make it possible for your existing immune system to fight the cancer. The targeted immunotherapies used to treat some types of skin cancer include Yervoy® (ipilimumab), Keytruda® (pembrolizumab), Opdivo® (nivolumab), cemiplimab-rwlc (Libtayo®), Bavencio® (avelumab), and atezolizumab (Tecentriq®).