A Case of an Elderly Patient of Hypopharyngeal Carcinoma Developed Thrombocytopenia during Radiotherapy with Cetuximab

Abstract

We present herein an 85-year-old patient with advanced hypopharyngeal carcinoma who developed thrombocytopenia during treatment with cetuximab plus radiotherapy. He had a medical history of diabetes mellitus and atrial fibrillation and was taking 3.5 mg of oral warfarin per day. At the time when the third dose of cetuximab was administered, the patient experienced a high-grade fever—thought to be an infusion reaction—followed by thrombocytopenia, which improved with platelet transfusion. After radiotherapy was finished, a hematoma was observed in the iliopsoas muscle on a CT scan. The prothrombin time-international normalized ratio (PT-INR) was elevated to an extremely high level of >8.0, which caused by warfarin. Thrombocytopenia owing to cetuximab is a very rare but adverse event that may occur severely in elderly patients. Therefore, it is necessary to choose the treatment carefully for them. In addition, patients with carcinoma receiving anti-coagulant therapy should be assessed for risk factors and frequently monitored for blood coagulation during anti-cancer treatment.