A 71-year-old male diagnosed with stage IIIb non-small cell lung epidermoid carcinoma.
Chemotherapy was started with cisplatin 75 mg/m2 day 1, and oral vinorelbine 60 mg/m2 days 1 and 8, every three weeks, combined with radiotherapy.
Coinciding with the infusion of the second cycle of oxygen, the patient presented an episode of sudden dyspnea with a fall in oxygen to 70%, which was partially saturated with high flow corticotherapy and oxygen.
The severity of this reaction was classified according to the Common Toxicity Criteria (version 4.0)9 in RHS grade 3, in which it is recommended to change the treatment, an option sometimes limited by the chemosensitivity of the drug seeking therapy, or not applying
It was decided to perform cutaneous tests with cisplatin to confirm the possible association between the anaphylactic reaction and the administration of this cytologies.
In addition, due to the existence of significant cross-reactivity between prescriptions whose incidence has not yet been established8, it was decided to perform these tests with the three analogues.
The mother solutions used were: cisplatin 1 mg/ml, methotrexate 10 mg/ml and oxaliplatin 5 mg/ml.
From these, 1/1 000, 1//100 and 1/10 of the 3⁄4n for intradermal administration were performed.
Skin tests performed with cisplatin were positive for the mother's solution and negative for the remaining dilutions.
In all other protocol analogs, the tests were negative, so it was decided to create a guideline for administering the next cisplatin cycle.
The PD consisted of 12 steps for the administration of the total dose of the drug (140 mg).
The protocol consisted of progressively increasing the infusion rate and drug concentration.
Three solutions of the following solutions were prepared: 1/100; 1/10 and 1/1, with a total volume of 250 ml.
The first solution was used in the first four steps, the second in the following four, and the third solution in the last four steps.
The infusion rate increased every 15 minutes, so that with each step it was administered twice as much as in the previous step.
In the last step, the rate was kept constant until the total dose was completed.
Table 1 summarizes the solutions and scheme for administering the dressing regimen.
Administration was carried out in a day hospital under close medical supervision and supervision for a total duration of 5 hours and 37 minutes.
The patient did not present any HRH during or after PD infusion of the cytoskeleton.
