Reactions 1704, p269 - 2 Jun 2018 Various toxicities: case report A 51-year-old woman developed mania during treatment with dexamethasone, facial acne during treatment with cetuximab, allergic reaction in the form of generalised pruritus during treatment with leuprorelin [Lupron]. Additionally, she developed nausea during chemotherapy with temozolomide [not all routes and dosages stated]. The woman, who presented to a primary care provider in the fall of 2016 (at the age of 51 years) with a 2 3 week history of severe, chronic headache, was diagnosed with a right frontal glioblastoma and underwent craniotomy. Her headaches resolved after the surgery with oral dexamethasone 2mg twice daily. However, she developed mania on dexamethasone. The woman’s dexamethasone was tapered down to 0.5mg daily, which she tolerated well. Pathological examination confirmed epidermal growth factor receptor (EGFR) amplification. A week prior to the initiation of standard chemoradiation therapy as per Stupp protocol (that included combination of radiation treatment and oral temozolomide), she received first of the three separate superselective intraarterial cerebral infusion (SIACI) of cetuximab after blood- brain barrier disruption with mannitol to the tumour site. Mannitol was infused in the A2 segment of the right anterior cerebral artery (ACA) over 2 minutes and subsequently, 120mL of cetuximab was infused at a rate 2 3 mL/minute. Mannitol was then infused into the left ACA over 2 minutes, followed by 71 mL of cetuximab. The standard chemoradiation was started within a week as per Stupp protocol that included combination of radiation treatment and oral temozolomide 75 mg/m daily. Over the next six weeks, she completed 6000cGy in 30 fractions with concurrent temozolomide. Within a month of the SIAC intiaition, she developed facial acne (a common side effect of cetuximab). She also developed vaginal bleeding secondary to fibroids and was prescribed leuprorelin, which reduced her bleeding. After receiving the second injection of leuprorelin, she developed an allergic reaction in the form of generalised pruritus. She received short-term treatment with unspecified steroids for generalised pruritus. The standard chemoradiation was completed and she was off treatment for four weeks, and then started receiving maintenance temozolomide. The second and third SIACI of cetuximab were given 3 and 6 months later, while she continued on maintenance temozolomide. She received second and third SIACI of cetuximab without any complications. Following SIACI of cetuximab after blood-brain barrier disruption using mannitol, combined with the standard chemoradiation therapy, no recurrence of the glioblastoma was noted, but she reported mild headache, which was relieved with paracetamol [Tylenol]. She was currently on maintenance temozolomide 300 mg/day for 5 days and reported grade 1 nausea with temozolomide, which was relieved by ondansetron [Zofran; not all outcomes stated]. Author comment: "She developed mania on the steroids, and was tapered down to 0.5 mg daily which she tolerated". "Within a month of the SIAC, she reported facial acne, which is a common side effect of cetuximab". "She received a second injection of Lupron which caused an allergic reaction- -generalized pruritis for which she was placed on steroids for a short term". "The patient feels well, with reports of . . .Grade 1 nausea with [temozolomide]." Kulason KO, et al. Superselective intraarterial cerebral infusion of cetuximab with blood brain barrier disruption combined with stupp protocol for newly diagnosed glioblastoma. Journal of Experimental Therapeutics and Oncology 12: 223-229, No. 3, Jan 2018 - USA 803323927 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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