|Denileukin Diftitox (Ontak®)|
| Last Modified: August 21, 2011
Pronounced: DEN-i-LOO-kin DIF-ti-tox
About Denileukin Diftitox
Denileukin diftitox is a type of medication called a "biologic response modifier". It is designed to target the CD25 component of the IL-2 receptor, which is found on the malignant cells of patients with certain cancers. When bound to the receptor, the drug inhibits synthesis of certain proteins, and thus causes cell death. The medication only works in tumors that have the CD25 receptor, so testing should be done for this before starting the medication.
How to Take Denileukin Diftitox
Denileukin diftitox is given through intravenous (into a vein) infusion, over a period of 30-60 minutes, but can take longer depending on the patient's reaction to the infusion. It is given for 5 consecutive days, every 21 days. The actual dose is dependent on your body size. Premedication with acetaminophen (Tylenol) and diphenhydramine (Benadryl) will be given to lower the risk of infusion reactions.
Possible Side Effects of Denileukin Diftitox
There are a number of things you can do to manage the side effects of Denileukin Diftitox. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:
Infusion-Related Side Effects
The denileukin diftitox infusion can cause a reaction that may include low blood pressure, back pain, shortness of breath, rash, and chest pain. The infusion may be stopped or slowed down if this occurs, and steroids (hydrocortisone or decadron), diphenhydramine, and epinephrine may be given to stop the reaction. These reactions generally occur within 24 hours of the dose, and most often occur during the first and second cycles.
This occurs in more than 90% of patients. Flu-like syndrome occurs hours to days after the infusion and is characterized by fever, chills, weakness, nausea, vomiting, and muscle and joint aches. Medications such as acetaminophen and anti-nausea medications can be used to manage these symptoms.
Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods that absorbs fluid and can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange and grapefruit sections, boiled potatoes, white rice and products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration. Read Low Fiber Diet for Diarrhea for more tips.
Rash with or without itching may occur. Antihistamines (like diphenhydramine) or topical steroids can be used to control symptoms. It is important to prevent scratching and breaking of the skin, given the already high risk for skin infections in patient with CTCL, now at even higher risk on this therapy. Some patients also reported tingling or burning of the skin.
Low White Blood Cell Count (Leukopenia or Neutropenia)
White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4 F), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.
Tips to preventing infection:
For more suggestions, read the Neutropenia Tip Sheet.
Low Red Blood Cell Count (Anemia)
Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your doctor or nurse know if you experience any shortness of breath, difficulty breathing or pain in your chest. If the count gets too low, you may receive a blood transfusion. Read the anemia tip sheet for more information.
Nausea and/or Vomiting
Take anti-nausea medications as prescribed. If you continue to have nausea or vomiting, notify your doctor or nurse so they can help you manage this side effect. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms. Read the Nausea & Vomiting Tip Sheet for more suggestions.
Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.
Capillary Leak Syndrome
Capillary leak syndrome is a potentially serious complication in which fluids from the veins and capillaries leak into the tissue outside the bloodstream. This results in low blood pressure and poor blood flow to the internal organs. Capillary leak syndrome is characterized by the presence of 2 or more of the following 3 symptoms: low blood pressure, swelling, and low levels of protein in the blood (hypoalbuminemia). Your doctor will monitor these levels while you are taking denileukin diftitox. You should notify your doctor immediately if you notice dizziness (especially when changing position), sudden swelling or rapid weight gain, little or no urine output (for 8-12 hours), shortness of breath, difficulty breathing, irregular heart beats, or chest pain. This syndrome generally occurs within about 2 weeks of treatment.
While on cancer treatment you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team and see OncoLink's section on fatigue for helpful tips on dealing with this side effect.
Decrease in Appetite
Patients in clinical trials reported blurry vision and/or a loss of color vision. While this resolved in some patients, visual changes were persistent in most patients.