Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
Leg Med (Tokyo). 2021 Jul;51:101878. doi: 10.1016/j.legalmed.2021.101878. Epub 2021 Apr 7.
Cetuximab is mainly used for the treatment of advanced and metastatic colorectal cancer. Owing to the oligosaccharide galactose-α-1,3-galactose (α-gal) in its heavy chain, cetuximab can induce severe IgE-dependent anaphylaxis. α-Gal is also the antigen responsible for α-gal syndrome, known as mammalian meat allergy. Patients with α-gal syndrome may suffer from cetuximab-induced anaphylaxis at the first administration because of developed α-gal-specific IgE antibodies. A male patient in his 50 s with metastatic colon cancer was receiving chemotherapy involving scheduled cetuximab administration. However, he died soon after the first administration. Forensic autopsy confirmed rectal cancer, metastatic rectal cancer in the liver, and renal cancer. Laboratory blood tests revealed the presence of cetuximab- and beef-specific IgE antibodies before cetuximab administration and an extremely high level of tryptase after administration. Thus, we determined that the death was caused by cetuximab-induced anaphylaxis due to the preexisting α-gal syndrome. To the best of our knowledge, this is the first autopsy case report in forensic medicine of fatal anaphylaxis after initial cetuximab administration.
西妥昔单抗主要用于治疗晚期和转移性结直肠癌。由于其重链中的寡糖半乳糖-α-1,3-半乳糖（α-gal），西妥昔单抗可诱导严重的 IgE 依赖性过敏反应。α-gal 也是引起 α-gal 综合征的抗原，也称为哺乳动物肉过敏。由于产生了针对 α-gal 的特异性 IgE 抗体，α-gal 综合征患者在首次使用西妥昔单抗时可能会发生西妥昔单抗诱导的过敏反应。一名 50 多岁的男性转移性结肠癌患者正在接受包括定期西妥昔单抗给药的化疗。然而，他在第一次给药后不久就去世了。法医尸检证实为直肠癌、肝转移直肠癌和肾癌。实验室血液检查显示，在使用西妥昔单抗之前存在针对西妥昔单抗和牛肉的 IgE 抗体，并且在使用后存在极高水平的类胰蛋白酶。因此，我们确定死亡是由预先存在的 α-gal 综合征引起的西妥昔单抗诱导的过敏反应引起的。据我们所知，这是法医首次报告首例初始西妥昔单抗给药后发生致命过敏反应的尸检病例。
