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Management of Hypertriglyceridemia in Patients Receiving Interferon for Malignant Melanoma

Associate Professor of Pharmacy Practice, Western University College of Pharmacy, Pomona, CA

James G Jakowatz, MD

Associate Clinical Professor of Surgery, Department of Surgical Oncology, University of California Irvine Medical Center, Irvine, CA

Reza Taheri, PharmD

at time of writing, faculty member, Western University College of Pharmacy; now, Assistant Professor of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, CA

Reprints: Siu-Fun Wong PharmD, Western University College of Pharmacy, 309 E. Second St., Pomona, CA 91766-1854, fax 909/469-5539, siuwong{at}westernu.edu

OBJECTIVE: To describe 3 cases of hypertriglyceridemia associated with the use of interferon alfa (IFN-) for the treatment of malignant melanoma and propose a management plan for dyslipidemia associated with interferon therapy.

CASE SUMMARIES: Three case reports of hypertriglyceridemia with or without elevation of total cholesterol level associated with the use of adjuvant IFN- for the treatment of malignant melanoma are described. These patients received IFN--based adjuvant therapy with doses ranging from 5–20 million units/m² for 1–2 years' duration. The onset and severity of dyslipidemia appeared to occur randomly. Pre-existing cardiovascular disorders did not seem to play a role. The patients were treated with atorvastatin, gemfibrozil, and a combination of lovastatin with niacin, depending on their lipid panel results.

DISCUSSION: Based on our case reports and published data, hypertriglyceridemia is more frequently associated with longer duration of interferon therapy, although the time of onset is not clearly defined. Presence or absence of baseline dyslipidemia does not seem to play a role in the development of hypertriglyceridemia associated with interferon, and its occurrence and severity are not dependent on the dose. Lifestyle modifications should be encouraged in patients who develop dyslipidemia, and drug treatment should be considered. If drug therapy is indicated, fibric acid derivatives should be considered as first-line therapy. Even at lower doses, this class of drug seems to be effective in managing severe triglyceride elevations in these patients. The Naranjo probability scale of these cases ranged from possible to probable.

CONCLUSIONS: Hypertriglyceridemia is a rare but potentially severe adverse consequence of interferon therapy. Patients with malignant melanoma who develop dyslipidemia while receiving interferon should be considered for antidyslipidemic management.

Key Words: hypertriglyceridemia, interferon-, malignant melanoma, management

Published Online, August 10, 2004. www.theannals.com, DOI 10.1345/aph.1D546

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