Fever with IPI

Hi Bruce,

I’m not sure how much help this will be for you, and I’ll preface this by saying this is anecdotal. In a handful of months preceding my diagnosis, I would get night sweats, maybe once a week. Once I was diagnosed, I was immediately started on ipi/nivo. Shortly after my first infusion I started to get night sweats plus low grade fevers that started in the afternoon like yours. The sweats would vacillate between being hot and then the chills, and the body aches. Mine never went above 100, I don’t think, but then I wouldn’t rush to take my temperature at 3am when I’d wake up in a puddle while simultaneously sweating and shivering. I just tried to go back to sleep.

I associated the fevers with an immune response, during this time the large lump of disease on my neck shrunk noticeably. I took Advil a couple times (stayed away from Tylenol because I was trying to protect my liver), but the fevers and chills and sweats would always resolve by morning anyway, so I stopped. The fevers stopped sometime shortly after my second combo infusion, and apparently so did my response to the combo treatment, last scans I had report that my disease has progressed.

How often do you spike a 100+ fever? If its every day, then I would agree that perhaps more Motrin/Aleve is in order. Mine were a couple times a week, and because I was seeing results, I was more inclined to let that fever eat. However, I was having a lot of pain on the side of my face, as well as headaches due to the location of the disease (I feel like it must have been pushing on a nerve) so we discussed ibuprofen for pain relief, and he told me to take 600mg every 4 hours. Higher dosages of ibuprofen won’t hurt your liver like tylenol, though it can be hard on your stomach, so an antacid might be in order if that happens. That apparently is a thing – my mother has a prescription for 800mg ibuprofen combined with prilosec or zantac or one of those acid reducers, for her arthritis, all in one pill.

I’ll close by saying that you of course shouldn’t alter your medications without checking with your onc first, but upping your dose of ibuprofen shouldn’t cause too much hand wringing.

I had a fever for three days, a month after my second combo infusion. It always came around 4-5 p.m. and lasted until 10-11 p.m. A week later my liver enzymes skyrocketed and I ended up in the hospital on steroids. Your fever maybe different, however I think it is a good thing since your body is reacting to the treatment. I had excellent shrinkage even with just two infusions.
The reason your Dr. told you to alternate between Tylenol and Motrin was because together they are even more effective not only as fever reducers but for extreme pain as well.
Best wishes,
Melanie