Leucovorin-induced Hypersensitivity Reaction in a Patient with Metastatic Colorectal Cancer Treated with Cetuximab Plus FOLFOX Chemotherapy: A Case Report.

Minna Kim, Dong Hyun Kim, Jong Yoon Lee, Young-Hee Nam, Jong Hoon Lee
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Abstract

The FOLFOX regimen (combination of leucovorin, 5-fluorouracil, and oxaliplatin) is the first-line treatment for high-risk stage 2 and 3 colorectal cancer patients. While hypersensitivity reactions (HSRs) caused by oxaliplatin are commonly reported, HSRs due to leucovorin have been infrequently reported. This report aims to investigate the clinical presentation, diagnosis, and management of leucovorin induced HSRs. A 60-year-old female developed generalized edema, dyspnea, and facial redness during cetuximab plus FOLFOX chemotherapy administered for management of metastatic colorectal cancer. Because HSRs induced by oxaliplatin are commonly reported, we initially presumed an oxaliplatin-induced HSR. However, despite undergoing oxaliplatin desensitization, HSRs persisted, and they were still observed when leucovorin was administered without oxaliplatin. The patient was diagnosed with leucovorin-induced HSR and underwent leucovorin desensitization. However, the reactions recurred within 30 minutes of the initiating the desensitization. Considering unsuccessful leucovorin desensitization, leucovorin was excluded. The patient received cetuximab and oxaliplatin chemotherapy without leucovorin to date without any adverse effects. While leucovorin-induced HSRs are infrequently reported, they should still be regarded as potential adverse effects.

一名接受西妥昔单抗加 FOLFOX 化疗的转移性结直肠癌患者的亮菌甲素诱发高敏反应:病例报告。
FOLFOX 方案(亮菌素、5-氟尿嘧啶和奥沙利铂的组合)是高风险 2 期和 3 期结直肠癌患者的一线治疗方案。由奥沙利铂引起的超敏反应(HSR)屡见报端,而由亮菌甲素引起的超敏反应却鲜有报道。本报告旨在探讨亮菌甲素引起的超敏反应的临床表现、诊断和处理方法。一名 60 岁女性在接受西妥昔单抗加 FOLFOX 化疗治疗转移性结直肠癌期间出现全身水肿、呼吸困难和面部发红。由于奥沙利铂诱发 HSR 的报道屡见不鲜,我们最初推测是奥沙利铂诱发的 HSR。然而,尽管接受了奥沙利铂脱敏治疗,但 HSR 仍持续存在,而且在不使用奥沙利铂的情况下使用亮菌甲素时仍可观察到 HSR。患者被诊断为亮铂诱导的 HSR,并接受了亮铂脱敏治疗。然而,在开始脱敏治疗后的 30 分钟内,反应再次出现。考虑到亮菌甲素脱敏治疗不成功,亮菌甲素被排除在外。患者接受了西妥昔单抗和奥沙利铂化疗,至今未使用亮菌甲素,也未出现任何不良反应。虽然亮菌甲素诱发 HSR 的报道并不常见,但仍应将其视为潜在的不良反应。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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