Interferons

Types / brand names:

  • Interferon alfa 2b (Intron®A)
  • Interferon alfa 2a (Roferon®A)
  • Interferon gamma 1b (Actimmune®)

Interferons (IFN) are naturally occurring compounds that are produced by human cells in response to many triggers of the immune system. IFN have anti-virus, anti-cancer and immune stimulating effects. Synthetic forms of recombinant IFN have been manufactured for the treatment of a variety of diseases including viral infection, auto-immune disease and cancer. The three categories of IFN include alpha, beta and gamma. Interferon alpha has been studied more widely in CTCL, but in recent years, IFN gamma has been used in patients that have failed IFN alpha. It has been the experience of some physicians that interferon gamma may be better tolerated by the elderly than  interferon alpha. It appears to cause fewer cognitive side effects. IFN beta is use in the treatment of multiple sclerosis. The effectiveness of IFN in CTCL is believed to be due to its ability to boost the immune system's response to CTCL cells.

Two synthetic (recombinant) forms of IFN-alpha are commercially available: interferon-alfa 2a (Roferon®A) and IFN alfa 2b (Intron®A). The only difference between the two is one molecule (amino acid) but both are equally effective.

IFN-alpha is given by subcutaneous injection. Patients who are initiated on IFN therapy are required to learn how to give themselves injections, much like a diabetic patient injecting insulin. The usual dose schedule is three injections per week. 

Patients receiving IFN therapy are expected to have frequent blood tests performed to monitor blood counts and liver enzymes. 

When IFN is initiated, nearly all patients experience flu-like symptoms (fatigue, muscle aches, and fever) that may be lessen with ongoing treatment. More serious side effects include depression/anxiety/sleep disturbance, stomach upset, hair loss, increased risk for infection, and elevated blood pressure. 

The following measures are helpful in the alleviation of IFN related side effects:

  • Pre-medication with acetaminophen (eg, Tylenol®), prior to interferon injection, can be used to help prevent or partially alleviate the fever and headache.
  • Bedtime administration of IFN therapy may allow you to sleep through the "flu-like" symptoms of therapy.
  • Conserve your energy; try to get plenty of rest.
  • Drink plenty of fluids; keep yourself well hydrated before and during therapy.
  • Eat balanced meals; make sure you are getting an adequate amount of calories in your diet.

IFN is usually used in intermediate to advanced cases of cutaneous T-cell lymphoma (Stage II-B, III, and IV). When IFN is initiated as a single form of therapy, patients usually will remain on it for at least three to six months. If there is no improvement during this period of time, the dose or frequency of the IFN may be combined with either skin-based or other systemic therapies.