Celecoxib Combined with Thalidomide in the Treatment of Refractory Neoplastic Fever in Advanced Cholangiocarcinoma: A Case Report

Neoplastic fever, a common symptom of tumors, can be mainly controlled by nonsteroidal antiinflammatories (NSAIDs) and corticosteroids. However, there is no standard treatment guideline for refractory neoplastic fever, which cannot be controlled by the medicines mentioned above. This report presents a case of advanced cholangiocarcinoma with persistent fever lasting 3 weeks. After ineffective treatment with various antibiotics, ibuprofen, and corticosteroids, the body temperature returned to normal after a 48-hour treatment with celecoxib + thalidomide. Finally, the overall survival (OS) of the patient reached 8 months with radiotherapy and chemotherapy.

Treatment of neoplastic fever and sweats in two cancer patients with oxybutynin.

128 Background: Treatment for neoplastic fevers and sweating (NFS) is usually accomplished successfully with non-steroidal drugs (NSAIDs) such as naproxen, but such therapies may be contraindicated in some patients due to drug interactions, bleeding diathesis, renal disease, or cirrhosis. Options for treating NFS in such patients are limited. Methods: We report the first use of oxybutynin (OxyB), commonly used for hyperhidrosis and increasingly used for hormonally mediated hot flashes (Smith TJ, NEJM 2018; Leon-Ferre R, SABCS 2018, under review in JNCI Cancer Spectrum, for NFS in NSAID-ineligible or refractory patients. Results: Two patients with NFS were treated. The first was a 70 year old (yo) woman with cholangiocarcinoma with 3 months of NFS for whom naproxen was ineffective and who was starting chemotherapy. Within 2 hours after 2.5 mg OxyB q12h her sweating was gone, and her fever, which had been up to 100.4F, never resumed. The second was a 52 yo male with cirrhosis and hepatocellular carcinoma who was prescribed 2.5 mg q12h OxyB with lysis of his fever within hours and cessation of his sweating. To date, over one month has passed with no reduction in efficacy. Conclusions: OxyB may be a successful treatment modality for patients with NFS who cannot be treated with or are refractory to NSAIDs. Further research is warranted to ensure stability of results over time and to monitor for side effects.