Grade 3 infusion-related reaction because of cetuximab administered with 5-fluorouracil and cisplatin chemotherapy for a recurrent and metastatic head and neck cancer patient who received chlorpheniramine 5 mg, dexamethasone 13.2 mg, and aprepitant 125 mg premedication

Abstract

Cetuximab (Cmab), an Immunoglobulin G1 monoclonal antibody targeting the epidermal growth factor receptor, is associated with Epidermal Growth Factor Receptor inhibitor-specific adverse drug reactions, such as skin toxicities and infusion-related reactions (IRRs). IRRs have been reported in 6–18% of patients receiving Cmab, with grade 3 and 4 reactions in 1–5% in head and neck cancer patients. Premedication with corticosteroids may prevent or dampen non-Immunoglobulin E (IgE) mediated infusion reactions. We encountered a case in which a grade 3 IRR occurred secondary to Cmab that was combined with 5-fluorouracil and cisplatin (5fluorouracil and Cisplatin +Cmab) chemotherapy for a recurrent and metastatic head and neck cancer patient who had received premedication consisting of chlorpheniramine 5mg, dexamethasone 13.2mg, and aprepitant 125mg. Non-IgE-mediated reaction and cytokine release syndrome can be prevented by premedication. The patient had grade 3 IRRs because of Cmab, even though we used a higher dose of corticosteroid, dexamethasone 13.2mg, and aprepitant. Severe IRRs because of Cmab occurred despite administration of a higher dose of dexamethasone, compared with the ordinary dose that ranges from 3.3 to 6.6mg. Furthermore, his rapid symptom after Cmab intravenous administration confirmed to typical IgE-mediated reaction even though he received high dose of dexamethasone and chlorpheniramine. To prevent a critical situation due to severe Cmab IRRs is early first aid treatment when a patient has hypertensive reactions. Monitoring for symptoms of Cmab-induced IRRs requires not only the supervision of oncologists, nurses, and pharmacists but also patient awareness of the condition.