Sir,

Immunotherapy for cancer is a new treatment modality for management of advanced cancer. It is accepted as a useful additional therapy. Nimotuzumab is a new immune-based targeted therapy against cancer.[1,2] Targeting at the binding site of the epidermal growth factor is the main pharmacological reaction for management of cancer.[1,2] Since it is a new drug, the concern on the effectiveness as well as an adverse effect is very important. Here, the authors present a case experience an adverse effect after starting nimotuzumab therapy. The patient was an old Thai male case with stage 4 lung cancer, just diagnosed for 1 week, and receiving standard nimotuzumab therapy (400 mg/body weekly, intravenous infusion over 30 min) at the first time. This case is naïve case without any previous other cancer therapy. In this case, there is no problem during the drug administration. However, on the way to the patient's home, 15 min after complete drug administration, the patient abruptly developed chill and headache symptoms. The patient was brought back to the clinical center for management. The vital signs showed no fever, but hypertension, blood pressure (BP) =160/100 mmHg (the underlying BP for this patient was 120/80 mmHg). This patient was laid down, kept warm, and provided oral rehydration. After closed monitoring for 30 min, all symptoms disappeared and the patient's BP returned normal. The described adverse event is believed to be due to the sudden immune response to the immunotherapy. The patient did not get the continuous dose of nimotuzumab, but change to classical chemotherapy.

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