Efficacy and safety of tocilizumab for neoplastic fever in patients with advanced solid tumors: a multicenter...

Neoplastic fever (NF) severely impairs quality of life and often limits antitumor therapy, yet effective treatment remains lacking. Given the central role of interleukin-6 (IL-6), we evaluated tocilizumab for NF management.

We retrospectively reviewed NF cases at 3 Chinese hospitals (2019-2023). Patients who received tocilizumab and had evaluable follow-up data were included in analyses of fever resolution, afebrile duration, Karnofsky Performance Status, inflammatory markers, antitumor outcomes, and adverse events (AEs). In patients with sequential exposure to non-steroidal anti-inflammatory drugs (NSAIDs) and tocilizumab, changes in inflammatory markers after each treatment were compared.

Forty-five patients were identified (median age 65). All had elevated CRP and IL-6. Among 22 treated with tocilizumab, all achieved fever resolution within 24 hours, sustained for ≥2 weeks, with significant reductions in CRP (mean, 95.7-19.0 mg/L) and other inflammatory markers. Median afebrile duration was 3 weeks, extended to 4 weeks with re-treatment. Systemic therapy was subsequently administered in patients with poor baseline performance, who achieved an objective response rate of 50%, a median progression-free survival of 11.6 months, and an overall survival of 21.3 months. AEs occurred in 81.8% (grade ≥3, 31.8%) but were manageable. Compared with NSAIDs, tocilizumab uniquely improved anemia and inflammatory control.

Tocilizumab provided rapid and durable fever resolution with systemic anti-inflammatory effects, accompanied by functional and hematologic improvement. These findings suggest IL-6 blockade as a promising therapeutic option for NF.