Pemetrexed Induced Life-threatening Anaphylaxis

Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related death. The American Society for Clinical Oncology (ASCO) recommends platinum based regimens as the first-line of treatment for NSCLC. Pemetrexed, an antifolate agent, has been approved by the ASCO for the treatment of advanced non-squamous NSCLC and has been shown to be efficient for first-line, maintenance and second- or third-line treatment in this subgroup. It is administered intravenously over 10 minutes and is usually well tolerated with a very few side effects. There have been a few cases of anaphylaxis reported with pemetrexed use and most of the patients presented only with cutaneous manifestations. We present a patient with stage IV adenocarcinoma of the lung who developed a severe life threatening anaphylactic reaction requiring ventilatory support after administration of pemetrexed.