A Case of Possible Infusion-Related Reactions Caused by Palonosetron

An infusion-related reaction (IRR) is an adverse event that typically occurs when cytotoxic drugs or monoclonal antibodies are administered. Palonosetron, a 5-hydroxytryptamine 3 receptor antagonist, is commonly used to prevent chemotherapy-induced nausea and vomiting. IRRs due to palonosetron are very rare, with only two reports of anaphylactic shock due to palonosetron to date. We report a case with an IRR other than anaphylaxis.

A 75-year-old man with metastatic pancreatic cancer was receiving palliative chemotherapy. The patient repeatedly developed mild chills, shivering, fever and hypertension during or after infusion of cytotoxic agents such as liposomal irinotecan, gemcitabine, albumin-bound paclitaxel or oxaliplatin. Finally, as the IRR developed immediately after palonosetron, we concluded that palonosetron, which had been used as premedication in all previous regimens in which IRRs had occurred, was the causative agent.

Hypertension was considered to be one of the symptoms of IRR, although not typical. The rarity of palonosetron-induced IRRs and the delayed onset of IRRs made it difficult to establish that palonosetron was the cause of the IRRs. This report presents a rare case of IRR caused by palonosetron and details the course of IRR with palonosetron, which may help in the early recognition and appropriate management of future IRR with palonosetron.