Originally published as JCO Early Release 10.1200/JCO.2009.23.5333 on July 20 2009

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Reply to P. Mohr et al

Second Department of Internal Medicine-Propaedeutic, Oncology Section, University General Hospital Attikon, Athens, Greece

Urania Dafni

Laboratory of Biostatistics, University of Athens School of Nursing, Athens, Greece

Helen Gogas

First Department of Medicine, University of Athens Medical School, Laiko Hospital, Athens, Greece

In the letter by Mohr et al,¹ it is proposed that a crucial aspect not addressed by our study² relates to patients' quality of life during long-term treatment with high-dose interferon alfa-2b (IFN--2b). A quality-of-life questionnaire was not completed by patients who participated in our study, but toxicity was recorded and graded according to the National Cancer Institute Common Toxicity Criteria. This was decided in 1997 by the protocol team, and patients presenting with psychiatric disorders were assessed by psychiatrists. Rates of psychiatric disorders of any grade were higher in arm B (receiving 1 month of high-dose IFN--2b intravenously followed by 48 weeks of maintenance therapy with 15 x 10⁶ U/m² of IFN--2b subcutaneously three times per week), but a majority of adverse events were of grades 1 to 2 in severity. Psychiatric disorders involved depressive episodes, mood instability, mania, and irritability. We agree that depression seems to have a low impact on IFN--2b tolerability, which is in accordance with the presentation³ on the German Dermatologic Cooperative Oncology Group trial at the 2007 ASCO Annual Meeting and the article by Bannink et al.⁴ However, as the mechanisms underlying fatigue, depression and cognitive slowing associated with IFN- therapy seem to be largely mediated by the direct and indirect effects of IFN- on the hypothalamus.⁵ Because the different criteria and methods used by researchers make the actual incidence of depression difficult to ascertain, the final results of the German Dermatologic Cooperative Oncology Group trial are awaited with interest.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Although all authors completed the disclosure declaration, the following author(s) indicated a financial or other interest that is relevant to the subject matter under consideration in this article. Certain relationships marked with a "U" are those for which no compensation was received; those relationships marked with a "C" were compensated. For a detailed description of the disclosure categories, or for more information about ASCO's conflict of interest policy, please refer to the Author Disclosure Declaration and the Disclosures of Potential Conflicts of Interest section in Information for Contributors.

Employment or Leadership Position: None Consultant or Advisory Role: Helen Gogas, Schering-Plough (C) Stock Ownership: None Honoraria: None Research Funding: None Expert Testimony: None Other Remuneration: None

REFERENCES

1. Mohr P, Hauschild A, Trefzer U, et al: Quality of life in patients receiving high-dose interferon alfa-2b after resected high-risk melanoma. J Clin Oncol 27:e70; 2009.[Free Full Text]

2. Pectasides D, Dafni U, Bafaloukos D, et al: Randomized phase III study of 1 month versus 1 year of adjuvant high-dose interferon alfa-2b in patients with resected high-risk melanoma. J Clin Oncol 27:939–944, 2009.[Abstract/Free Full Text]

3. Mohr P, Hauschild A, Trefzer U, et al: Health-related quality of life measures in melanoma patients receiving pulsed high-dose intravenous interferon alpha 2b (IFN2b). J Clin Oncol 25:481s; 2007 (suppl) abstr 8536.

4. Bannink M, Kruit WH, Van Gool AR, et al: Interferon-alpha in oncology patients: Fewer psychiatric side effects than anticipated. Psychosomatics 49:56–63, 2008.[CrossRef][Medline]

5. Kirkwood JM, Bender C, Agarwala S, et al: Mechanisms and management of toxicities associated with high-dose interferon alfa-2b therapy. J Clin Oncol 20:3703–3718, 2002.[Abstract/Free Full Text]

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• Quality of Life in Patients Receiving High-Dose Interferon Alfa-2b After Resected High-Risk Melanoma
  Peter Mohr, Axel Hauschild, Uwe Trefzer, and Michael Weichenthal
  JCO 2009 27: 70 [Full Text]

This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Google Scholar Articles by Pectasides, D. Articles by Gogas, H. PubMed PubMed Citation Articles by Pectasides, D. Articles by Gogas, H. Related Articles Related Article Social Bookmarking                            What's this?