THE EFFECT OF NAPROXEN ON FEVER IN PATIENTS WITH ADVANCED GYNECOLOGICMALIGNANCIES

The antipyretic action of naproxen has been reported as sufficiently s elective for neoplasm-related fever such that the use of this agent ha s been recommended to distinguish neoplastic from infectious fever. Th e antipyretic effect of naproxen was evaluated in gynecologic oncology patients with advanced pelvic malignancies and fever without obvious source of infection (suspected neoplastic fever). Naproxen (250 mg ora lly every 8 hr) was given to 12 patients with (i) a daily temperature greater than 38.3 degrees C, (ii) fever for at least 3 days, (iii) no evidence of infection on physical exam, (iv) negative results of blood and urine cultures, and (v) a chest roentgenogram negative for pneumo nia. Ten of the 12 patients initially received a minimum of 3 days of empiric antibiotic therapy without resolution of fever. Within 24 hr o f starting naproxen therapy, 10 patients' (83%) fever responded: Eight patients (80%) had a complete lysis of fever and two had partial lysi s (20%). Temperature response was accompanied by subjective improvemen t in patient malaise and fatigue. Naproxen therapy was continued for 5 -7 days in these patients, and chemotherapy was administered to those patients scheduled to receive it. Two patients did not respond to napr oxen therapy in 24 hr; thus, it was stopped and the fever workup was c ontinued. Of these two patients, one was eventually diagnosed with bac teremia after multiple negative blood cultures and initially no respon se to antibiotics. Naproxen is clinically useful in the palliation of fever-related symptoms in gynecologic oncology patients with suspected neoplastic fever. Naproxen may also allow the limitation of extensive fever work-ups and prolonged empiric antibiotic therapy in these pati ents, and prevent delays in systemic therapy or supportive care. (C) 1 995 Academic Press, Inc.