Possible Role for Tocilizumab, an Anti–Interleukin-6 Receptor Antibody, in Treating Cancer Cachexia

Abstract

A 75-year-old man with no significant past medical history presented with a 3-week period of fever, fatigue, and a 7-kg weight loss. Physical examination revealed a poor performance status (PS; Eastern Cooperative Oncology Group score 3), emaciation, and anemia of palpebral conjunctiva. Laboratory data included a WBC count of 15.7 K/L, moderate anemia (hemoglobin concentration of 7.2 g/dL), and a platelet count of 757 K/L. Serum chemistry showed total protein, albumin, and C-reactive protein (CRP) of 8.5 g/dL, 1.7 g/dL (globulin was 50% in the protein fraction), and 24.51 mg/dL, respectively. In addition, serum immunoglobulin G was increased (4.3 g/dL) as was interleukin-6 (IL-6; 172 pg/mL). A computed tomography (CT) scan of the thorax showed a 3-cm mass in the right hilum and swelling of mediastinal lymph nodes, although there was no evidence of metastasis in remote organs. Accordingly, we considered a differential diagnosis of lung cancer, Castleman's disease, or tuberculosis. Subsequent endobronchial ultrasound-guided transbronchial needle aspiration resulted in the detection of a large-cell carcinoma and a final diagnosis of primary lung cancer at clinical stage T2aN2M0 (stage IIIA) with cancer cachexia.