FEVER IN MALIGNANT NEOPLASTIC DISEASE: A CONTROLLED STUDY OF TETRACYCLINE THERAPY

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Abstract
The etiology of fever accompanying neoplastic disease when no infection is apparent is entirely obscure. Most forms of malignant tumors are associated with unexplained fever although the frequency of fever varies greatly with the particular form of neoplasm. Inapparent infection has been considered a cause of many of the unexplained episodes of fever and consequently a trial of antibacterial therapy has been advocated. In a previous study we detailed the evidence against infection being a frequent cause of such fever and presented evidence that antibiotic therapy should be used with caution in the patient with depressed host defense mechanisms. In order to further investigate these problems, tetracycline therapy was compared to placebo therapy in fever of undetermined origin by a double blind method in patients with an acute leukemia, Hodgkin''s disease and other neoplasms. No beneficial effect of tetracycline could be deduced. The frequency and severity of superimposed infections was suggestively greater in patients receiving tetracycline and unfavorable alterations occurred in their bacterial and mycotic ecology. We concluded that the unexplained fevers found in neoplastic disease are rarely due to occult infection and that antibacterial therapy in such patients is inadvisable.