Genetically Proxied Interleukin-6 Inhibition and Cancer Risk: A Multi-Ancestry Drug-Target Mendelian Randomization Study of Hepatocellular Carcinoma and Colorectal Cancer
Background: Interleukin-6 (IL-6) signalling drives chronic inflammation and is therapeutically targeted by tocilizumab, an approved IL-6 receptor inhibitor. Whether genetically proxied lifelong IL-6 inhibition causally influences the risk of hepatocellular carcinoma (HCC) or colorectal cancer (CRC) remains unanswered. Prior single-variant estimates from pooled observational data are methodologically limited and may reflect confounding. Methods: A two-sample drug-target Mendelian randomization (MR) study was conducted. Four independent cis-acting protein quantitative trait loci (pQTL) variants within the IL6 and IL6R gene loci (rs2228145, rs4129267, rs7529229, rs1800795) were selected as genetic instruments , with F-statistics ranging from 32.3 to 120.5, confirming instrument strength. Outcome data were obtained from four independent genome-wide association studies: HCC from BioBank Japan (BBJ; 1,866 cases, 195,745 controls), HCC from FinnGen Release 10 (674 cases, 218,118 controls), CRC from a European meta-analysis (19,948 cases, 12,124 controls), and CRC from BBJ (7,062 cases, 195,745 controls). Causal estimates were derived using inverse variance weighted (IVW) regression as the primary method, with MR-Egger and weighted median analyses as sensitivity methods. Cochran Q statistics assessed heterogeneity and MR-Egger intercept testing assessed directional pleiotropy. Results: Genetically proxied IL-6 inhibition showed no significant causal effect on HCC risk in East Asian populations (IVW odds ratio [OR] 0.997, 95% confidence interval [CI] 0.903 to 1.101, p=0.953) or European populations (IVW OR 0.984, 95% CI 0.802 to 1.208, p=0.880). Similarly, no causal effect was observed on CRC risk in European populations (IVW OR 1.015, 95% CI 0.957 to 1.075, p=0.623) or East Asian populations (IVW OR 0.999, 95% CI 0.948 to 1.052, p=0.971). Sensitivity analyses confirmed the absence of directional pleiotropy and heterogeneity across all four analyses. Leave-one-out analyses demonstrated that no single instrument drove the null findings. Conclusions: Genetically proxied IL-6 receptor inhibition, modelling the therapeutic effect of tocilizumab, showed no causal effect on HCC or CRC risk across four independent cohorts and two ancestries. These findings do not support a role for IL-6 pathway inhibition in the prevention of these cancers and provide reassuring genetic safety evidence regarding cancer risk in patients receiving tocilizumab. Larger HCC-specific GWAS are needed to definitively evaluate modest effects in this cancer type.