Cetuximab, which is also known as Erbitux®, is mainly used to treat cancers that affect the large bowel (colon and rectum) or the head and neck. Cetuximab may also be used to treat other types of cancer as part of a research trial.
You'll see your doctor regularly while you have this treatment so they can monitor its effects. This information should help you discuss any queries about your treatment and its side effects with your doctor or specialist nurse.
Cetuximab belongs to a group of cancer drugs known as monoclonal antibodies. Monoclonal antibodies are sometimes called targeted therapies because they work by ‘targeting’ specific proteins (receptors) on the surface of cells.
Some types of cancer have large numbers of receptors on their surface called epidermal growth factor receptors (EGFRs). When the receptors are activated they trigger the cancer cells to divide and grow.
Cetuximab locks on to the EGFRs. This stops them from stimulating the cancer cells to divide and grow. It may also make the cancer cells more sensitive to the effects of chemotherapy and radiotherapy. Cetuximab is most likely to work for cancers with large numbers of EGFRs on their surfaces.
Cetuximab only works for bowel cancers that have a normal KRAS gene. So before it's used to treat bowel cancer, the cancer cells are tested to see if there are changes (mutations) in the KRAS gene. This helps the doctors decide if treatment with cetuximab is appropriate. Cancer cells can be tested during the same procedure that diagnoses the cancer. Or tests can be done using cells from previous biopsies or surgery. This test is not needed for head and neck cancers.
When cetuximab is used
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Cetuximab is licensed as a treatment for advanced (metastatic) large bowel cancer and for head and neck cancer. It’s also being tested in research trials as a possible treatment for other types of cancer.
The National Institute for Health and Clinical Excellence (NICE) gives advice on which new drugs or treatments should be available on the NHS in England and Wales. The Scottish Medicines Consortium (SMC) makes recommendations on the use of new drugs within the NHS in Scotland. Both NICE and the SMC have issued guidelines on when cetuximab can be used by the NHS.
Cetuximab for bowel cancer
Cetuximab is licensed to treat advanced bowel cancer:
in combination with chemotherapy
as a treatment on its own for people who have already been treated with the chemotherapy drugs oxaliplatin and irinotecan.
NICE and the SMC have both approved cetuximab in combination with chemotherapy as a possible treatment for bowel cancer that has spread to the liver, but hasn’t previously been treated with chemotherapy. The guidance doesn’t recommend cetuximab for everyone in this situation. Your cancer specialist can tell you if it's appropriate for you.
Cetuximab for head and neck cancer
Cetuximab is licensed to treat:
head and neck cancers that have started to spread into surrounding tissues (locally advanced head and neck cancers). It’s given in combination with radiotherapy.
head and neck cancers that have come back after treatment (are recurrent) or have spread (advanced or metastatic). It’s given in combination with a chemotherapy regimen containing a platinum drug (such as cisplatin).
NICE and the SMC have both recommended the use of cetuximab in combination with radiotherapy to treat locally advanced head and neck cancers. However, neither of them recommend cetuximab in combination with a platinum-based chemotherapy as a treatment for metastatic head and neck cancer.
If you live in Northern Ireland, speak to your cancer specialist about whether cetuximab is recommended to treat your type of cancer.
If cetuximab isn’t recommended for you it may not be available on the NHS, although you may be given it as part of a clinical trial. We have more information about what you can do if a treatment isn’t available.
What cetuximab looks like
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Cetuximab is a colourless liquid.
How cetuximab is given
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Cetuximab is given as a drip into a vein (intravenous infusion). The first infusion involves a larger dose of cetuximab that is given slowly, over about two hours. Afterwards you'll stay in the clinic for about an hour to make sure that you don’t have a reaction to the infusion.
After the first infusion, the following infusions are given once a week and take about an hour.
Possible side effects of cetuximab
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Each person’s reaction to cancer treatment is different. Some people have very few side effects while others may experience more. The side effects described here won't affect everyone having this treatment.
We have outlined the most common side effects, but haven't included those that are rare and therefore unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor or specialist nurse.
The side effects of cetuximab are generally mild, and some of these can be reduced with medicines. The side effects of chemotherapy and radiotherapy can also be increased by having cetuximab as well.
Side effects of cetuximab fall into one of two groups:
infusion-related side effects, which occur during the infusion (while you’re receiving the treatment) or for up to an hour afterwards (or rarely up to several hours later)
later side effects, which may occur after a few days or weeks of treatment.
Infusion-related side effects
These are usually mild or moderate, but rarely, they can be more severe. You may be given drugs before the infusion to reduce the chance of a reaction happening.
If you do have a reaction, this can usually be treated by slowing or stopping the drip until the reaction is over. Any future infusions will be given at a slower rate.
You’ll be monitored closely during your treatment, but tell your nurse or doctor if you feel unwell or have any of the following symptoms:
flu-like symptoms, such as headache, feeling flushed, having a fever, chills or dizziness
red, warm and itchy bumps on the skin (like nettle rash)
a feeling of swelling in the lips, tongue or throat
breathlessness, wheezing, a cough or sudden difficulty breathing
a tight chest or chest pain.
Rarely, an infusion-related reaction can happen a few hours after treatment. If you develop any of the symptoms above or feel unwell after you get home, contact the hospital straight away for advice.
Later side effects
Mild skin rashes on the face, neck and body that are similar to acne are a very common effect of cetuximab. They begin during the first three weeks of treatment and usually go away completely when the treatment stops. Some people have more severe skin changes, which can include reddening of the skin and red pimples and spots on the face. Skin on the face may also become flaky and scaly. Some people have dry skin similar to eczema on their fingertips, elbows and extremities. This may be sore and itchy. If you have any of these skin changes, let your doctor know straight away.
If you have very severe skin problems, the length of time between the treatments may be extended or the dose may be lowered. Treatment can be prescribed by your doctor to reduce the rash.
To help reduce dry skin, try to avoid things that make your skin dry, such as central heating and soap. Your doctor can prescribe creams to moisturise your skin.
Some skin reactions can be made worse by exposure to the sun. You can still go out in the sun, but should wear a sun cream with a high sun protection factor (SPF) and cover up with clothing and a hat. We have a page about taking care of your skin in the sun.
Feeling sick (nausea) and being sick (vomiting)
Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness isn't controlled, or if it continues, tell your doctor as they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Some people find that cetuximab causes headaches. Let your doctor or nurse know. They can give you painkillers to relieve this.
Cetuximab can cause diarrhoea. This can usually be easily controlled with medicine but tell your doctor if it is severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Treatment with cetuximab may cause changes in the way that your liver works, although it will return to normal when the treatment finishes. You're very unlikely to notice any problems, but your doctor will take regular blood samples to check your liver is working properly.
Feeling tired is a common side effect of cetuximab, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with taking some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
These occur less commonly than skin changes, but sometimes develop after three months or more. Your eyelashes may grow longer and more curly than usual. Men may notice they have less beard growth. You may notice that your head and body hair is finer, curlier or more brittle. A few people have hair loss. If this happens, it usually develops gradually over several months. These changes are usually temporary and gradually improve once treatment is over.
Reduced levels of magnesium in the blood
You will have regular blood tests and may be given magnesium supplements if the levels are too low.
Cetuximab may cause an inflammation of the lining of the eyelids (conjunctiva) that makes your eyes feel sore, red and itchy. Let your doctor know so they can prescribe soothing eye drops if necessary.
Some people may become breathless. This is more likely if you have an existing lung problem. Let your doctor know if you notice any increase in breathlessness.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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Some medicines, including those that you can buy in a shop or chemist, can be harmful to take when you are having cetuximab. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
Little is known about the effects of cetuximab on a developing baby. Therefore, it is not advisable to become pregnant or father a child while taking this drug.
It’s not known whether cetuximab is present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after treatment.
There is a potential risk that cetuximab may be present in breast milk, so women are advised not to breastfeed during cetuximab and for a few months afterwards.
Non-cancer hospital admission
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you’re having cetuximab treatment. You should tell them the name of your cancer specialist so that they can ask them for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. During office hours you can contact the clinic or ward where you had your treatment. Your specialist nurse or doctor will tell you who to contact during the evening or at weekends.
This information has been compiled using a number of reliable sources, including:
British National Formulary. 63rd edition. British Medical Association and Royal Pharmaceutical Society of Great Britain. 2012.
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed October 2012).
National Institute for Health and Clinical Excellence (NICE). Cetuximab, bevacizumab and panitumumab for the treatment of metastatic colorectal cancer after first-line chemotherapy: Cetuximab (monotherapy or combination chemotherapy), bevacizumab (in combination with non-oxaliplatin chemotherapy) and panitumumab (monotherapy) for the treatment of metastatic colorectal cancer after first-line chemotherapy (TA242). 2012.
National Institute for Health and Clinical Excellence (NICE).Cetuximab for the treatment of locally advanced squamous cell cancer of the head and neck cancer (TA145). 2008.
National Institute for Health and Clinical Excellence (NICE). Cetuximab for the treatment of recurrent and/or metastatic squamous cell cancer of the head and neck cancer (TA172). 2009.
National Institute for Health and Clinical Excellence (NICE).Cetuximab for the first-line treatment of metastatic colorectal cancer (TA176). 2009.
Scottish Medicines Consortium (SMC). 543/09 - Cetuximab (Erbitux). 2010.
Scottish Medicines Consortium (SMC). 547/09 - Cetuximab (Erbitux). 2009.
Scottish Medicines Consortium (SMC). 279/06 - Cetuximab 2mg/ml intravenous infusion (Erbitux). 2006.
With thanks to Bruce Burnett, Consultant Pharmacist, and the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when you join our Cancer Voices network.