# Case Report: A case of severe hypotension induced by nimotuzumab in a nasopharyngeal carcinoma patient

## TL;DR

A patient with nasopharyngeal cancer experienced severe hypotension after nimotuzumab treatment, highlighting the need for close blood pressure monitoring.

## Contribution

This case report highlights a rare severe adverse effect of nimotuzumab not previously emphasized in clinical guidelines.

## Key findings

- A 65-year-old NPC patient developed severe hypotension after 5 cycles of nimotuzumab treatment.
- Exclusion of other causes confirmed nimotuzumab as the likely cause of hypotension.
- Discontinuation of nimotuzumab and norepinephrine administration stabilized the patient’s blood pressure.

## Abstract

Nimotuzumab, a humanized immunoglobulin G1 monoclonal antibody, is mainly used in combination with radiotherapy for the treatment of stage III/IV nasopharyngeal carcinoma (NPC) or locally advanced head and neck squamous-cell carcinoma (HNSCC) with positive epidermal growth factor receptor (EGFR) expression. Although the drug has a favorable safety profile, it is associated with various adverse reactions, among which hypotension is relatively uncommon. Clinically, hypotension caused by nimotuzumab mainly manifests as mild blood pressure (BP) reduction, which can be relieved via rest. This case reports a 65-year-old male patient with advanced NPC who developed severe persistent hypotension after receiving radiotherapy combined with 5 cycles of nimotuzumab treatment. After excluding related factors such as cardiac function, endocrine function, thyroid function, inflammatory factors and other drugs, the adverse reaction was considered to be closely associated with nimotuzumab. After discontinuing the drug and giving continuous norepinephrine to increase BP, the patient’s BP returned to stable. This case suggests that although nimotuzumab-related hypotension is mostly mild and reversible, BP monitoring should still be strengthened to maintain vigilance against severe hypotension and intervene promptly in clinical practice.