Borner, M.

Helbling, D.

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Successful challenge with thefully human EGFR antibodypanitumumab following aninfusion reaction with thechimeric EGFR antibodycetuximabInfusion reactions are serious complications associated withmodern antibody therapy. In order to reduce the incidenceand severity of such reactions, the newer generations ofmonoclonal antibodies contain less or no mouse-specific proteinsequences. We describe the clinical course of a patient whoexperienced an infusion reaction following the administration ofthe chimeric epidermal growth factor receptor (EGFR) antibodycetuximab and who was then successfully challenged with thefully human EGFR antibody panitumumab.A 39-year-old white male with metastatic colon cancer wasscheduled to receive cetuximab monotherapy as third-linetreatment. Despite premedication with dexamethasone,clemastine and ranitidine the patient experienced an infusionreaction with massive urticaria mainly in the face and agitation5 min after cetuximab was started. The infusion was thenstopped and he recovered 30 min later following anotherinfusion with steroids and antihistamines. Ninety minuteslater, the cetuximab infusion was restarted with reducedinfusion rate but had to be stopped again 20 min later becauseof progressive urticaria and agitation. No subsequentcetuximab was given. Due to rapid tumor progression and lackof therapeutic alternatives, the patient was planned to receivepanitumumab. For safety reasons, the patient was monitoredon the intensive care unit during the first and second infusionswith panitumumab. The patient was premedicated withcetrizine. No infusion reaction occurred and the patientAnnals of Oncology letters to the editorVolume 18 |No. 5 |May 2007 letters to the editor | 963received in total six infusions of panitumumab 6 mg/kg i.v. >60min every 2 weeks. Serum for antipanitumumab antibodies wascollected before the first panitumumab infusion and at week 7;no antipanitumumab antibodies were detected.To our knowledge, this is the first report of a patient withdocumented hypersensitivity to the chimeric EGFR antibodycetuximab who was then exposed to the fully human EGFRantibody panitumumab. The patient experienced no infusionreactions nor did the patient exhibit any symptoms indicativeof a potential allergic response to panitumumab. Cetuximabhas been associated with infusion reactions of any grade in19% of patients (severe infusion reactions in 3% ofpatients) [1]. Severe events were characterized by rapid onsetof airway obstruction, urticaria, hypotension and/or cardiacarrest [1]. The majority of infusion reactions (90%) occurredduring the initial infusion despite antihistamine prophylaxis[1]. Infusion reactions to panitumumab are very rare. In thepivotal phase 3 trial of panitumumab plus best supportive care(BSC) versus BSC alone, no grade 3 or 4 infusion reactionsoccurred. One patient (<1%) had an infusion reaction (grade2) to panitumumab and discontinued treatment (Peeters M,Van Cutsem E, Siena S et al., submitted for publication) [2].These data and our case report indicate that there may beindeed differences in the hypersensitivity profile between anti-EGFR antibodies. Further studies of panitumumab focusing oninfusion events in patients who are intolerant to cetuximabare warranted.D. Helbling* & M. BornerDepartment of Medical Oncology, Clinic of Medical Oncology, UniversityHospital Inselpital Bern, Freiburgstrasse, 3010 Bern, Switzerland(*E-mail: daniel.helbling@insel.ch)references1. Erbitux (cetuximab) prescribing information. ImClone Systems, Inc. 2006.2. Van Cutsem E, Peeters M, Siena S et al. Panitumumab significantly improvesprogression-free survival in patients with metastatic colorectal cancer. Ann Oncol2006; 17 (Suppl 6): vi27 (Abstr O-027).doi:10.1093/annonc/mdm130letters to the editor Annals of Oncology964 | letters to the editor Volume 18 |No. 5 |May 2007

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

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