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Early Depressive Symptoms in Cancer Patients Receiving Interleukin 2 and/or Interferon Alfa-2b Therapy

From the Institut National de la Santé et de la Recherche Médicale U 394, Neurobiologie Intégrative, Institut François Magendie, and Institut Bergonié, Comprehensive Cancer Center, Bordeaux, France.

Address reprint requests to Lucile Capuron, PhD, Institut National de la Santé et de la Recherche Médicale U 394, Neurobiologie Intégrative, Institut François Magendie, Rue Camille Saint-Saëns, 33077 Bordeaux Cedex, France; email lucile.capuron{at}vignemale .bordeaux.inserm.fr.

PURPOSE: Depressive symptomatology is frequently associated with interleukin (IL)-2 and interferon alfa-2b (INF-2b) therapy in cancer patients. The objective of the present study was to evaluate the depressive and anxiety symptoms induced by IL-2 and/or INF-2b in cancer patients during the first days of cytokine immunotherapy.

PATIENTS AND METHODS: The study included 48 patients with renal cell carcinoma or melanoma. Patients were treated either with subcutaneous IL-2, alone (n = 20) or in combination with INF-2b (n = 6); or with INF-2b alone, administered subcutaneously at a low dose (n = 8) or intravenously at a high dose (n = 14). Depressive symptoms were evaluated using the Montgomery and Asberg Depression Rating Scale (MADRS), and anxiety symptoms were evaluated using the Covi scale. Evaluations were performed just before initiation of treatment (day 1) and on days 3 and 5 of treatment.

RESULTS: Patients treated with IL-2 alone or in association with INF-2b had significantly higher MADRS scores after 5 days of cytokine therapy, and patients who received both cytokines had increased scores on day 3. In contrast, patients treated with INF-2b alone did not have varying MADRS scores during the course of treatment. Cytokine therapy had no effect on anxiety, except in patients treated with IL-2 in combination with INF-2b. In these patients, the enhancement in anxiety scores that was observed on day 5 was mainly attributable to increased somatic complaints.

CONCLUSION: IL-2 and INF-2b have differential effects on mood, and IL-2 therapy induces depressive symptoms early in treatment.

Presented in part at the 35th Annual Meeting of the American Society of Clinical Oncology, Atlanta, GA, May 15-18, 1999.

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