Successful challenge with the fully human EGFR antibody panitumumab following an infusion reaction with the chimeric EGFR antibody cetuximab.

Infusion reactions are serious complications associated with modern antibody therapy. In order to reduce the incidence and severity of such reactions, the newer generations of monoclonal antibodies contain less or no mouse-specific protein sequences. We describe the clinical course of a patient who experienced an infusion reaction following the administration of the chimeric epidermal growth factor receptor (EGFR) antibody cetuximab and who was then successfully challenged with the fully human EGFR antibody panitumumab. A 39-year-old white male with metastatic colon cancer was scheduled to receive cetuximab monotherapy as third-line treatment. Despite premedication with dexamethasone, clemastine and ranitidine the patient experienced an infusion reaction with massive urticaria mainly in the face and agitation 5 min after cetuximab was started. The infusion was then stopped and he recovered 30 min later following another infusion with steroids and antihistamines. Ninety minutes later, the cetuximab infusion was restarted with reduced infusion rate but had to be stopped again 20 min later because of progressive urticaria and agitation. No subsequent cetuximab was given. Due to rapid tumor progression and lack of therapeutic alternatives, the patient was planned to receive panitumumab. For safety reasons, the patient was monitored on the intensive care unit during the first and second infusions with panitumumab. The patient was premedicated with cetrizine. No infusion reaction occurred and the patient Annals of Oncology letters to the editor