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 详细处方信息以本药内容附件PDF文件（201222300374938.pdf）的“原文Priscribing Information”为准
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部分中文Proleukin处方资料（仅供参考）

阿地白介素主要成份为重组人白细胞介素，为多肽类免疫增强剂。能够诱导干扰素和多种细胞因子的分泌。临床用于肿瘤辅助治疗和癌性胸、腹水的治疗。

中文别名：阿地白介素、阿地流津、白介素-2、重组人白介素-2 、普留净 　　

英文别名：Proleukin 、Aldesleukin

药品类别：其它抗肿瘤药 　　

药理药动：
本品的生物活性作用与天然的人体IL-2相似，能产生淋巴因子(淋巴激活素)，不但有助于调节细胞的正常生长，而且促进免疫系统细胞的分化。 　　
IL-2与具专一性、高度亲合力的细胞表面受体结合，以活化的T细胞表达，此外它还存在于某些淋巴细胞内。IL-2使细胞毒淋巴细胞活化及活化的T细胞分化。IL-2激发免疫效应器细胞，产生各种继发的细胞因子，如γ-干扰素和肿瘤坏死因子(TNF)等。 　　
动物模型实验表明IL-2的抗肿瘤作用与剂量及应用方案有关。对患轻度肿瘤的动物用本品治疗有效。致免疫性和宿主的免疫系统状况影响实验动物接受IL-2治疗的效果。 　　

药动学：IL-2的药代动力学几乎呈线性关系。静脉输注后2h达到与剂量成正比的稳坪状态，一旦停止输注后血药浓度迅速下降。本品主要通过肾脏排泄。 　　

适 应 症：治疗成人(18岁以上)转移性肾细胞癌。 　　

用法用量：转移性肾细胞癌成人患者用本品治疗每个疗程为五天，间歇一段时间重复治疗五天。 　　
成人剂量：每日静脉输注1mg/平方米(体表面积)，连续5天，停药2～6天，再每日静注1mg/平方米，连续5天。间歇3周后再重复。若肿瘤缩小不需重复下个疗程。若肿瘤继续生长，本品治疗最长可达12个月。出现不良反应，应停药而不是减少剂量。 　　
维持量：每日静注1mg/平方米，连续5天。间歇4～5周再如前重复，至多4次。儿童不宜使用。 　　
[制剂与规格]注射用冻于粉针剂。每瓶22或18MIU。 　　

不良反应：
最常见的不良反应可能由于血管血液渗漏综合征所引起的包括发热、寒战、体重增加和低血压，但由此引起的死亡率较小。
255例转移性肾细胞癌患者单用本品治疗的因药物引起的死亡率4%(11例/255例)。不良反应的发生率和严重程度一般与剂量及用药方案有关。多数不良反应是暂时和可逆性的，停用本品后2或3天内消除。常见不良反应有心肌梗塞、肠穿孔/梗阻，坏疽。最常见报道的严重不良反应包括低血压、肾功能障碍(尿少或无尿)、呼吸困难或肺充血、精神状态变化(如昏睡、瞌睡、意识模糊和焦虑)。其它不良反应包括：心肌缺血、心肌炎、呼吸衰竭、胃肠道出血(需手术)、肠穿孔/肠梗阻、昏迷、癫痫发作、脓毒症和肾功能损害(需透析)。罕见关节痛、腹水、肌痛、甲状腺机能减退、高血糖、低血钙、高血钾。 　　

禁忌症：禁用于孕期及哺乳妇女，严重心脏病、严重的感染、缺氧症、主要器官功能障碍，中枢神经系统转移瘤或癫痫症及自体免疫病患者。 　　
对本品或本品制剂中任何组分发生过敏者、肺功能试验严重异常者、同种器官移植者禁用。 　　
早期治疗使用本品曾发生不良反应者，如持续室性心动过速(>5次)，心律紊乱不能控制或对处理无效，兼有FCG变化的反复胸痛、心绞痛或心肌梗塞，心包填塞，肾功能障碍需透析72h以上者；昏迷或毒性精神病持续48h以上者；反复发作或难以控制的癫痫者；肠缺血/穿孔，胃肠道出血需手术者禁用。 　　
以下患者慎用：老年人，肾或肝功能不良者，毛细血管渗漏综合征者，严重贫血、白细胞或血小板减少者。 　　

白介素2 的作用介绍（IL-2）
1． IL-2对T细胞的作用 IL-2是T细胞生长因子，能使T细胞在试管内长期存活，刺激T细胞进入细胞分裂周期。IL-2能增强T细胞的杀伤活性，在体外它与IL-4、IL-5和IL-6一起共同诱导细胞毒性T细胞（Tc）的产生，并使其活性大大增强，延长其生长期；在体内IL-2也能增强抗原诱导的TC活性，甚至可以辅助抗原和半抗原直接在祼鼠体内诱导产生TC¬。 　　
由IL-2诱导产生的TC输入体内后可产生明显抗肿瘤作用，但TC在体内不易存活，如同时再输入少量IL-2，则可明显延长Tc在体内的存活时间，并增强其抗肿瘤效果。 IL-2并可诱导T细胞分泌IFN-γ, TNF, CSF等细胞因子。 　　
2．IL-2对NK细胞的作用 IL-2可促进NK细胞的增殖，维持NK细胞长期生长。肿瘤病人经IL-2治疗后，血中NK细胞数量明显增加。IL-2在体内、外都能增强NK细胞活性。在体外，IL-2于短时间内就可使NK细胞活性增强。肿瘤病人经IL-2治疗后NK细胞活性变明显增强，且有累积效应，即随着IL-2剂量的增加和疗程的延长，NK细胞活性亦因之不断增强，IL-2并能矫正NK细胞活性低下状态，使之恢复正常或超过正常。白血病病人外周血单核细胞（PBMC，其中10%是NK细胞），经IL-2培养后具明显的细胞毒作用，以此输回给病人治疗白血病。IL-2还能促进NK细胞分泌IFN-γ，增加其表达IL-2R+亚基等。 　　
3．IL-2对LAK、TIL细胞的作用 IL-2可促进LAK, TIL细胞的体外存活、扩增及活化LAM（即淋巴因子激活的杀伤细胞lymphokine activated killer cells）。LAK是淋巴细胞与IL-2接触后产生的一种具有高效抗肿瘤效应的杀伤细胞，只有在IL-2的存在下LAK才能产生，亦只有在IL-2存在下，LAK才能发挥其效果。实验证明，淋巴细胞经IL-2培育后所得LAK细胞的活力，比不加IL-2培育的强100~1000倍，而且LAK只识别肿瘤抗原，对宿主正常细胞没有影响。LAK与IL-2合用，对原发性及转移性肿瘤，均有明显抗肿瘤作用。 　　
LAK与IL-2合用治疗肿瘤虽取得了临床效果，但在制备LAK时须抽取病大量周围血单个核细胞，须多次回输并伴用大剂量IL-2，价格昂贵且毒副作用大，于是人们极力寻找一种抗肿瘤效果好、毒副作用小的方法于1986年从实体瘤组织中分离到肿瘤浸润性淋巴细胞(tumor infiltrating lymphocytes，TIL )，在体外经IL-2激活可大量扩增，并对肿瘤细胞具高度杀伤作用，其体外杀伤肿瘤的效果比LAK强50~100倍，并仅须伴用少量IL-2就可发挥明显抗肿瘤效果，毒副作用小。 　　
4．IL-2对B细胞的作用 　　
IL-2可促进B细胞表达IL-2R，促使B胞增殖和产生免疫球蛋白，并刺激巨噬细胞，提高其吞噬能力。近年发现，重组IL-2可刺激某些中枢神经细胞的生长和成熟，并作用于吗啡肽受体，产生镇痛作用。有关白细胞介素一2 (IL-2 )的调节免疫作用。 　　
5．IL-2对肿瘤细胞的作用 IL-2的抗肿瘤作用除与LAK, TIL有关外，还与其诱导NO的产生有关。实验发现对LAK无效的Meth A小鼠皮肤癌，用IL-2治疗可见存活期延长，且小鼠尿中NO2¬¬¬-含量较对照组高8倍；如同时应用NO诱导抑制剂L-NMMA，使尿中NO含量下降60%，同时使IL-2组的存活期大大缩短，提示IL-2诱导NO合成，是其抗肿瘤作用机制之一。

Summary of Important Safety Information for Proleukin® (aldesleukin) for injection, for intravenous infusion
WARNINGS
Therapy with Proleukin® (aldesleukin) should be restricted to patients with normal cardiac and pulmonary functions as defined by thallium stress testing and formal pulmonary function testing. Extreme caution should be used in patients with a normal thallium stress test and a normal pulmonary function test who have a history of cardiac or pulmonary disease.

Proleukin should be administered in a hospital setting under the supervision of a qualified physician experienced in the use of anticancer agents. An intensive care facility and specialists skilled in cardiopulmonary or intensive care medicine must be available.

Proleukin administration has been associated with capillary leak syndrome (CLS) which is characterized by a loss of vascular tone and extravasation of plasma proteins and fluid into the extravascular space. CLS results in hypotension and reduced organ perfusion which may be severe and can result in death. CLS may be associated with cardiac arrhythmias (supraventricular and ventricular), angina, myocardial infarction, respiratory insufficiency requiring intubation, gastrointestinal bleeding or infarction, renal insufficiency, edema, and mental status changes.

Proleukin treatment is associated with impaired neutrophil function (reduced chemotaxis) and with an increased risk of disseminated infection, including sepsis and bacterial endocarditis. Consequently, preexisting bacterial infections should be adequately treated prior to initiation of Proleukin therapy. Patients with indwelling central lines are particularly at risk for infection with gram positive microorganisms. Antibiotic prophylaxis with oxacillin, nafcillin, ciprofloxacin, or vancomycin has been associated with a reduced incidence of staphylococcal infections.

Proleukin administration should be withheld in patients developing moderate to severe lethargy or somnolence; continued administration may result in coma.

INDICATION AND USAGE
Proleukin® (aldesleukin) is indicated for the treatment of adults with metastatic renal cell carcinoma (metastatic RCC).

Proleukin is indicated for the treatment of adults with metastatic melanoma.

Careful patient selection is mandatory prior to the administration of Proleukin.

Evaluation of clinical studies to date reveals that patients with more favorable ECOG performance status (ECOG PS 0) at treatment initiation respond better to Proleukin, with a higher response rate and lower toxicity. Therefore, selection of patients for treatment should include assessment of performance status.

Experience in patients with ECOG PS >1 is extremely limited.

CONTRAINDICATIONS
Proleukin® (aldesleukin) is contraindicated in patients with a known history of hypersensitivity to interleukin-2 or any component of the Proleukin formulation.

Proleukin is contraindicated in patients with an abnormal thallium stress test or abnormal pulmonary function tests and those with organ allografts. Retreatment with Proleukin is contraindicated in patients who have experienced the following drug-related toxicities while receiving an earlier course of therapy: Sustained ventricular tachycardia (≥5 beats), Cardiac arrhythmias not controlled or unresponsive to management, Chest pain with ECG changes, consistent with angina or myocardial infarction, Cardiac tamponade, Intubation for >72 hours, Renal failure requiring dialysis >72 hours, Coma or toxic psychosis lasting >48 hours, Repetitive or difficult to control seizures, Bowel ischemia/perforation, GI bleeding requiring surgery.

WARNINGS
Because of the severe adverse events which generally accompany Proleukin® (aldesleukin) therapy at the recommended dosages, thorough clinical evaluation should be performed to identify patients with significant cardiac, pulmonary, renal, hepatic, or CNS impairment in whom Proleukin is contraindicated. Patients with normal cardiovascular, pulmonary, hepatic, and CNS function may experience serious, life threatening or fatal adverse events. Adverse events are frequent, often serious, and sometimes fatal.

Should adverse events, requiring dose modification occur, dosage should be withheld rather than reduced.

Proleukin has been associated with exacerbation of pre-existing autoimmune disease and inflammatory disorders. In some cases, the onset of new autoimmune diseases, such as vitiligo, may occur. Symptomatic hyperglycemia and/or diabetes mellitus have been reported during Proleukin therapy.

All patients should have thorough evaluation and treatment of CNS metastases and have a negative scan prior to receiving Proleukin therapy. New neurologic signs, symptoms, and anatomic lesions following Proleukin therapy have been reported in patients without evidence of CNS metastases. Neurologic signs and symptoms associated with Proleukin therapy usually improve after discontinuation of Proleukin therapy; however, there are reports of permanent neurologic defects. In patients with known seizure disorders, extreme caution should be exercised as Proleukin may cause seizures.

PRECAUTIONS
Patients should have normal cardiac, pulmonary, hepatic, and CNS function at the start of therapy. Capillary leak syndrome (CLS) begins immediately after Proleukin® (aldesleukin) treatment starts and is marked by increased capillary permeability to protein and fluids and reduced vascular tone.

Proleukin® (aldesleukin) treatment should be withheld for failure to maintain organ perfusion as demonstrated by altered mental status, reduced urine output, a fall in the systolic blood pressure below 90 mm Hg or onset of cardiac arrhythmias.

Recovery from CLS begins soon after cessation of Proleukin therapy. Usually, within a few hours, the blood pressure rises, organ perfusion is restored and reabsorption of extravasated fluid and protein begins.

Kidney and liver function are impaired during Proleukin treatment. Use of concomitant nephrotoxic or hepatotoxic medications may further increase toxicity to the kidney or liver.

Mental status changes including irritability, confusion, or depression which occur while receiving Proleukin may be due to bacteremia or early bacterial sepsis, hypoperfusion, occult CNS malignancy, or direct Proleukin-induced CNS toxicity. Patients should be evaluated for these and other causes of mental status changes. Alterations in mental status due solely to Proleukin therapy may progress for several days before recovery begins. Rarely, patients have sustained permanent neurologic deficits.

Proleukin enhancement of cellular immune function may increase the risk of allograft rejection in transplant patients.

Serious manifestations of eosinophilia involving eosinophilic infiltration of cardiac and pulmonary tissues can occur following Proleukin.

ADVERSE REACTIONS
The rate of drug-related deaths in the 255 metastatic RCC patients who received single-agent Proleukin® (aldesleukin) was 4% (11/255); the rate of drug-related deaths in the 270 metastatic melanoma patients who received single-agent PROLEUKIN was 2% (6/270).

In clinical trials, the following life-threatening (Grade 4) adverse events were seen in >1% of 525 patients (255 with metastatic renal cell cancer and 270 with metastatic melanoma) treated with PROLEUKIN: oliguria (6%), anuria (5%), hypotension (3%), respiratory disorder (3%), bilirubinemia (2%), coma (2%), diarrhea (2%), acidosis (1%), acute kidney failure (1%), apnea (1%), cardiovascular disorder (1%), coagulation disorders (1%), confusion (1%), creatinine increase (1%), dyspnea (1%), fever (1%), heart arrest (1%), infection (1%), myocardial infarct (1%), psychosis (1%), sepsis (1%), SGOT increase (1%), stupor (1%), supraventricular tachycardia (1%), thrombocytopenia (1%), ventricular tachycardia (1%), and vomiting (1%). From the same trials, the following adverse events (Grades 1-4) were seen in ≥30% of 525 patients (255 with metastatic renal cell cancer and 270 with metastatic melanoma) treated with PROLEUKIN: hypotension (71%), diarrhea (67%), oliguria (63%), chills (52%), vomiting (50%), dyspnea (43%), rash (42%), bilirubinemia (40%), thrombocytopenia (37%), nausea (35%), confusion (34%), and creatinine increase (33%).

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 详细处方信息以本药内容附件PDF文件（201222300374938.pdf）的“原文Priscribing Information”为准
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