Two cases of cetuximab-induced moderate to severe infusion reactions in oral cancer patients

Abstract

Here we report two cases in which treatment was necessary for infusion reaction (IR) to cetuximab in oral cancer patients. The first patient was a 64-year-old man with a diagnosis of mandibular gingiva squamous cell carcinoma (SCC) (T4bN2bM0). Cetuximab (Cmab) was administered after premedication with dexamethasone and chlorpheniramine. 20 minutes after the start of Cmab administration with dyspnea, low blood pressure (BP) at 54/33mmHg, low oxygen saturation (SpO₂) at 89%, and bradycardia with the heart rate at 39 beats per minute. Cmab was discontinued and the patient was treated with volume expansion, oxygen, intravenous hydrocortisone, and chlorpheniramine. The IR symptoms improved 60 minutes after administration of Cmab. The second patient was a 71-year-old man with a diagnosis of SCC on the floor of the mouth (T4aN2cM0). A Grade 3 IR occurred 15 minutes after the start of Cmab administration. The patient experienced dyspnea and physical examination indicated SpO₂ decreasing to 68% and low BP at 78/63mmHg. Cmab was discontinued and the patient was treated with volume expansion, oxygen, and administration of epinephrine, hydrocortisone, and chlorpheniramine. IR symptoms improved 70 minutes after administration of Cmab.