A 62-year-old patient, without known drug allergies, was receiving chronic glimese, bilastin, amyloidosis, irbesartan and hydrochlorothiazide treatment.
She was diagnosed with metastatic breast cancer, with negative hormone receptors and HER2 overexpressed, and started first-line treatment with paclitaxel associated with weekly trastuzumab.
Three doses of trastuzumab were administered without incidents.
During the infusion of the third dose of paclitaxel (premedicated as usual), once trastuzumab was administered, the patient suffered a severe infusional reaction with respiratory distress and shivering episodes and wheezing.
Treatment consisted of conservative management and intravenous administration of dexchlorpheniramine 5 mg and methylprednisolone 60 mg.
For this reason, trastuzumab was prescribed in triweekly combination with vinorelbine; during trastuzumab administration (4th dose in total), severe infusional reaction, the patient experienced severe abdominal pain.
It was treated in the same way as in the previous cycle with the addition of fluid therapy, with partial improvement of the clinical situation, with the appearance of fever and tiritena so it was decided to enter the patient's baseline reaction.
Five days later, the administration of the drug was programmed again, with the patient hospitalized with premedication (dexamethasone 20 mg, dexchlorpheniramine 5 mg, paracetamol 1 narrow g, all 50 mg and monitoring).
Initially, a test dose was administered at increasing speed, starting at 0.1 mg/h and duplicating velocity every 10 min, until administering 5 mg (total duration 82 min).
Given the good tolerance, the infusion was started with the rest of the dose, 440 mg, in 250 ml, programming 90 min of duration.
After 20 min the patient developed facial flushing, severe low back pain and profuse sweating. The drug was definitively discontinued (total dose administered 97 mg).
He received treatment with 300 mg hydrolytic agent, 5 mg of chlorpheniramine and 1 g of paracetamol, with symptomatic improvement, after which the dose of vinorelbine was administered without any additional incidence
