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Infusion Reaction — SCE Medical Oncology MCQ

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EasyOncological EmergenciesInfusion ReactionSCE Medical Oncology

A 62-year-old woman receiving trastuzumab-containing chemotherapy for gastric cancer develops a severe infusion reaction (rigors, bronchospasm, hypotension) during the second infusion. What is the immediate management?

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Correct answer: A — Stop the infusion immediately, administer adrenaline IM, IV hydrocortisone, IV chlorphenamine and IV fluids

Severe infusion-related reactions (grade 3-4: anaphylaxis/anaphylactoid) to monoclonal antibodies require immediate infusion cessation and anaphylaxis management per Resuscitation Council guidelines: IM adrenaline 500 mcg (1:1000), IV hydrocortisone 200 mg, IV chlorphenamine 10 mg, IV fluid resuscitation and supplemental oxygen. Trastuzumab should be permanently discontinued after a severe infusion reaction. Future anti-HER2 therapy options should be discussed at MDT.

Reference: BNF Trastuzumab monograph; Resuscitation Council UK Anaphylaxis Guidelines 2021; NICE CG Anaphylaxis