Successful desensitization of pemetrexed-induced anaphylaxis in a patient with malignant mesothelioma

Our plain-English summary of Successful desensitization of pemetrexed-induced anaphylaxis in a patient with malignant mesothelioma, by J. Youk, H. Park, K.N. Jin, et al (The Korean Journal of Internal Medicine, 2017).

The study

• Authors: J. Youk, H. Park, K.N. Jin, H.J. Moon, M.S. Yang, K.H. Kim, J.S. Kim
• Journal: The Korean Journal of Internal Medicine
• Published: 2017;32(3):563-565
• Type of article: Case report, Letter
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

In plain English

This letter to the editor was a case report about one patient: a 52-year-old woman in Korea with stage IV mesothelioma. A chest CT scan showed a 12.3 × 4.5 × 14.4 cm mass. The article did not describe any asbestos exposure. She received standard chemotherapy with cisplatin plus pemetrexed, and after six cycles her tumor showed a partial response. During the seventh cycle, 5 minutes after the pemetrexed infusion began, she had sudden dizziness, chills and a generalized skin rash. Her blood pressure fell to 86/49 and her oxygen saturation to 89%. The doctors suspected anaphylaxis (a severe allergic reaction), stopped the infusion and gave epinephrine, and her symptoms cleared within 20 minutes. Treatment then continued under a modified 12-step desensitization protocol, using three pemetrexed solutions of increasing strength. Apart from a mild skin rash, she received the full dose without another severe reaction. She went on to finish her 13th cycle while keeping a good partial response. The authors described this as the first report of successful desensitization to pemetrexed hypersensitivity.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (letter to the editor)
• Who was studied: one 52-year-old woman in Korea diagnosed with stage IV mesothelioma, with a 12.3 × 4.5 × 14.4 cm mass on chest CT
• Exposure: Chemotherapy with cisplatin plus pemetrexed. The article does not describe any asbestos exposure.
• Main results:
  • After six cycles of cisplatin plus pemetrexed, the patient's tumor showed a partial response on CT scans.
  • During the seventh cycle, the patient had a suspected anaphylactic reaction with blood pressure of 86/49 and oxygen saturation of 89%.
  • After the infusion was stopped and epinephrine given, the patient's symptoms resolved within 20 minutes.
  • Chemotherapy was continued using the modified Brigham and Women's Hospital (BWH) desensitization protocol, in 12 steps from three pemetrexed solutions of increasing strength.
  • Apart from a mild skin rash, the patient received a full dose of pemetrexed without another severe hypersensitivity reaction.
  • At the time of writing, the patient had finished the 13th cycle of treatment while maintaining a good partial response.
• The authors' conclusion: The authors concluded that rapid desensitization can let physicians avoid unwanted early interruptions of pemetrexed treatment. They described this as the first case of pemetrexed anaphylaxis reported in Korea.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pemetrexed (Alimta), Mesothelioma.

Related studies

• T cells expressing chimeric antigen receptors can cause anaphylaxis in humans — M.V. Maus, A.R. Haas, et al. (2013)
• Successful salvage chemotherapy with gemcitabine and vinorelbine in a malignant pleural mesothelioma patient previously treated with pemetrexed — T. Agatsuma, T. Koizumi, et al. (2010)
• Nursing considerations for administering pemetrexed (Alimta) in combination with cisplatin for malignant pleural mesothelioma — K.K. Orbaugh (2004)
• Inhibition of autophagy potentiates pemetrexed and simvastatin-induced apoptotic cell death in malignant mesothelioma and non-small cell lung cancer cells — K.E. Hwang, Y.S. Kim, et al. (2015)
• Effect of renal function on pemetrexed-induced haematotoxicity — Y. Ando, T. Hayashi, et al. (2016)
• A phase Ib study of GSK3052230, an FGF ligand trap in combination with pemetrexed and cisplatin in patients with malignant pleural mesothelioma — E.M.J. van Brummelen, E. Levchenko, et al. (2020)

Browse return to medical research.