Anti-IL-6R Ab tocilizumab to treat paraneoplastic inflammatory syndrome of solid cancers

• Published in: ESMO open 2025-01, Vol.10 (1), p.104088, Article 104088
• Main Authors: Blay, J.-Y., Brahmi, M., Dufresne, A., Swalduz, A., Avrillon, V., Assaad, S., Decroisette, C., Mastroianni, B., Dupont, M., Bourbotte-Salmon, F., Ray-Coquard, I., Meeus, P., Dutour, A., Castets, M., Perol, M., Heudel, P.
• Format: Article
• Language: English
• Subjects: IL-6; lung cancer; paraneoplastic inflammatory syndrome; sarcoma; tocilizumab
• ISSN: 2059-7029; 2059-7029
• DOI: 10.1016/j.esmoop.2024.104088

Paraneoplastic inflammatory syndrome (PIS) with fever and biological inflammation is a rare but severe condition often caused by the systemic production of interleukin 6 (IL-6) by cancer cells. We report on the efficacy of tocilizumab, an anti-IL-6 receptor antibody, in 35 patients with severe PIS. All 35 patients with solid cancers (sarcomas, lung carcinoma, and breast carcinoma) diagnosed with a PIS from 2019 to 2024 treated with tocilizumab were analyzed in this single-center study (health authorities’ approval R201-004-478). Patients’ characteristics and clinical and biological effects of tocilizumab administration are presented. Thirty-five (97%) patients had paraneoplastic fever. The median performance status (PS) was 2 (range 1-4). Forty percent of patients had lost 10% of body weight. All had increased serum C-reactive protein (CRP) levels (median 212 mg/l), and 74% and 48% had increased polymorphonuclear leukocyte (PMN) and platelet counts, respectively. Ninety-four percent had inflammatory anemia. Tocilizumab was given once in 23 (66%) patients and more than once in 12 patients. All patients experienced resolution of paraneoplastic fever, and 11 (31%) had improved PS. CRP, PMN, and platelet count decreases were observed in 100%, 85%, and 94% of patients, respectively. Seventy-seven percent of patients had increased hemoglobin levels. CRP and inflammatory symptoms often relapsed 4-6 weeks after tocilizumab in patients receiving only one injection. Tocilizumab is an efficient treatment for severe PIS providing significant improvement in clinical symptoms and biological abnormalities. •PIS with fever and inflammation is a severe condition associated with cancer.•PIS is often caused by the systemic production of IL-6 by cancer cells.•Tocilizumab, an anti-IL-6 receptor antibody, was administered in 35 patients with PIS.•All patients had paraneoplastic fever, increased serum CRP levels, and a biological inflammatory syndrome.•Tocilizumab provided a consistent and significant improvement in clinical and biological inflammation symptoms.