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This information is about cetuximab, which is also known as Erbitux®. It is used to treat people with cancers that affect the large bowel (colon and rectum|) or head and neck|. Cetuximab may also be used to treat other types of cancer as part of a research trial|.
Cetuximab is a type of drug known as a monoclonal antibody|. Monoclonal antibodies recognise and lock on to specific proteins (receptors) on the surface of cancer cells. This helps the body's immune system recognise the cancer cells and destroy them. Monoclonal antibodies are sometimes called targeted therapies because they are designed to target cancer cells.
Some types of cancers have receptors on their surface called epidermal growth factor receptors (EGFRs). When epidermal growth factor (a protein made in the body) attaches to the receptors, this triggers the cancer to grow and spread.
Cetuximab locks on to epidermal growth factor receptors. This stops them from stimulating the cancer to grow and spread.
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 is used to treat bowel cancer, the cancer cells are tested for changes (mutations) in the KRAS gene. This helps the doctors decide if the treatment is appropriate.
Testing can be done on samples of the cancer cells at the same time as diagnosis of the cancer or by using cells from previous biopsies or surgery.
Cetuximab is licensed as a treatment for large bowel cancer and for head and neck cancer. It is also being tested in research trials as a possible treatment for other types of cancer.
The National Institute for Health and Clinical Excellence (NICE|) and the Scottish Medicines Consortium (SMC|) currently give advice to the NHS in England, Wales and Scotland. Both NICE and the SMC have issued guidelines on when cetuximab can be used by the NHS.
NICE and the SMC have 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.
NICE and the SMC have approved cetuximab in combination with radiotherapy| to treat head and neck cancers that have started to spread into surrounding tissues (locally advanced head and neck cancers). Your cancer specialist can discuss with you whether cetuximab is recommended for you.
We can give you more information on what you can do if a treatment isn't available|.
Cetuximab is a colourless liquid.
Cetuximab is given as 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.
Each person’s reaction to a cancer drug is different. Some people have very few side effects while others may experience more. The side effects described here won't affect everyone taking cetuximab.
The side effects of cetuximab are generally mild and some of these can be reduced with medicines. When given with chemotherapy or radiotherapy, cetuximab may increase their side effects.
If you notice any effects that aren't listed here, discuss them with your doctor or specialist nurse.
Side effects of cetuximab fall into one of two groups:
These are usually mild or moderate but rarely can be more severe. You may be given drugs before the infusion to reduce the chance of a reaction.
If you do have a reaction, this can usually be treated by slowing or stopping the drip until the reaction is over. And, 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:
Rarely an infusion-related reaction can happen a few hours after treatment. If you develop the above symptoms or feel unwell after you get home, contact the hospital straight away for advice.
Mild skin rashes are very common with cetuximab. They begin during the first two 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. The skin of the face may also become flaky and scaly. Some people have dry skin, like eczema, on their fingertips, elbows and extremities, which is 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 eczema, try to avoid things that make your skin dry, such as central heating and soap. Your doctor can prescribe creams to moisturise your skin.
Feeling sick (nausea) and being sick (vomiting)
Your doctor can prescribe anti-sickness (anti-emetic)| drugs to prevent or greatly reduce this. If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
This can usually be controlled with medicine, but tell your doctor if it is severe or continues. It is important to drink plenty of fluids if you have diarrhoea|.
These occur less commonly than skin changes, but sometimes develop after three months or more. Your eyelashes may grow longer and curlier 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. We have more information about coping with hair loss|.
Your eyes may become sore, red and itchy. This is known as conjunctivitis. Your doctor can prescribe eye drops for this.
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.
It's not advisable to become pregnant or father a child while having cetuximab, as it may harm the developing baby. It’s important to use effective contraception while having this drug, and for at least a few months afterwards. You can discuss this with your doctor.
It’s not known whether biological therapies can be 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.
This section has been compiled using information from a number of reliable sources including:
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.