A case of IgE-mediated reaction-related anaphylactic shock after the initial administration of cetuximab − Pathogenesis of adverse events with respect to Pichler’s classification −

Abstract

Cetuximab produces antitumor effects by inhibiting the epidermal growth factor receptor (EGFR)-mediated signal transmission route of tumor cells. However, monoclonal-antibody-administration-related infusion reactions (IRs) or anaphylaxis may appear. We report a case of cetuximab-induced anaphylaxis in a patient with mandibular gingival cancer in whom beef-specific IgE antibodies were detected. The patient was an 81-year-old woman with gingival cancer (cT2N2bM1, adenocarcinoma, NOS low grade). To reduce bone-metastasis-related neurological symptoms, radiotherapy was performed. To treat the primary lesion and metastatic cervical lesions, cetuximab monotherapy was selected. On serum IgE antibody testing, beefspecific IgE was detected, and treatment was begun, given the possibility of anaphylaxis related to cetuximab administration. Anaphylactic symptoms, such as a decrease in blood pressure, urticaria, and loss of consciousness, appeared 20 minutes after the initial administration. Rapid infusion, oxygen administration, and vasopressor administration led to the resolution of shock. Subsequently, the additional administration of cetuximab was not conducted, and palliative radiotherapy (30 Gy/10 fractions) for cervical/thoracic vertebral metastases was performed, resulting in pain relief. The patient was discharged 24 days after admission. Among IRs, IgE-mediated allergic reactions should be pathophysiologically differentiated from standard infusion reactions (SIRs) , which are associated with hypercytokinemia. The onset of IgE-mediated allergic reactions may be avoided by discontinuing administration to patients in whom IgE antibody is detected on a beef-specific IgE antibody test before treatment.