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This information is about cetuximab, which is a drug used to treat people with cancer of the large bowel (colon| and rectum| ) and people with head and neck cancers. 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. In the UK it is currently used to treat cancer of the large bowel (colon| and rectum| ) that has come back after initial treatment and has spread to other parts of the body (known as advanced or metastatic cancer). In bowel cancer treatment, cetuximab may be given on its own or in combination with chemotherapy.
Cetuximab is also used with radiotherapy to treat locally advanced head and neck cancer. Or it may be used with chemotherapy to treat head and neck cancer that has come back or spread to other parts of the body.
Cetuximab is licensed and can be prescribed in the UK. 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.
NICE has approved cetuximab as a possible treatment for some people with head and neck cancer, as has the Scottish Medicines Consortium (SMC), an organisation similar to NICE.
NICE has also approved the use of cetuximab in combination with chemotherapy as a possible treatment for some people with bowel cancer that has spread to the liver. The NICE guidance doesn't recommend cetuximab for everyone in this situation. 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 being used in research trials to treat other types of cancer, including non-small cell lung cancer (NSCLC) and breast cancer. You may also be offered it as part of an early trial for other types of cancer. It is mainly given alongside chemotherapy or with radiotherapy.
Monoclonal antibodies are used to try to destroy some types of cancer cells while causing little harm to normal cells. They are designed to recognise certain proteins (receptors) that are found on the surface of particular cancer cells.
One type of receptor is known as epidermal growth factor receptors or EGFRs. When growth factors, such as epidermal growth factor, bind to the receptor, the cancer cell is stimulated to grow, divide and spread.
Cetuximab attaches itself to the EGFRs and prevents the receptors from being activated. This stops the cells from dividing. It therefore has the potential to stop the cancer cells from growing. It works in a different way from both chemotherapy and hormonal therapy.
Cetuximab may also make the cancer cells more sensitive to chemotherapy| and radiotherapy|.
Not all cancers respond to cetuximab. Before having cetuximab your doctors will test the cancer cells for a gene called KRAS. Knowing if the KRAS gene is normal or changed (mutated) can help the doctors decide whether cetuximab will be appropriate for you. This can help the doctors to know whether you are likely to benefit from this treatment. 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 a colourless liquid.
Cetuximab is given by a drip into the vein (intravenously) through a fine tube (cannula)inserted into a vein. The first dose is given slowly, usually over two hours. After this, doses are given weekly and normally take about an hour. The first dose is usually larger than the weekly maintenance treatments. You may be given other medicines before cetuximab to lessen the side effects during treatment.
Each person’s reaction to a cancer drug is different. Some people have very few side effects, while others may experience more. If you notice any effects which you think may be due to the drug, please discuss them with your doctor.
The side effects of cetuximab are generally mild and some of these can be reduced with medicines. When it is given with chemotherapy or radiotherapy, it may increase their side effects.
Allergic reactions Signs of an allergic reaction include skin rashes and itching, a feeling of swelling in the tongue or throat, irritation of the nasal passages, wheezing, a cough and breathlessness. You will be monitored closely during your treatment, but tell your nurse or doctor if you have any of these symptoms. To reduce the chance of developing an allergic reaction, certain drugs (antihistamines) can be given before the infusion. The drip can also be slowed down or stopped until the reaction is over.
Skin changes An acne-like rash, especially on the head, chest and back is common. This usually begins during the first two weeks of treatment and usually goes away completely when the treatment ends. Less commonly, skin may become dry and itchy. Or it may feel tender and peel.
If you have any skin changes, let your doctor know straight away. They can prescribe treatment to reduce the rash. Moisturising dry areas of skin may help to reduce symptoms such as itching. Your doctor can prescribe moisturising creams.
If you have severe skin problems the length of time between treatments may be extended or the dose may be lowered.
Breathlessness 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.
Feeling sick (nausea) and less commonly being sick (vomiting) Your doctor can prescribe very effective anti-sickness (antiemetic) drugs to prevent or greatly reduce nausea and vomiting| . If the sickness isn't controlled, or if it continues, tell your doctor, who can prescribe other anti-sickness drugs which may be more effective.
Diarrhoea This can usually be controlled with medicine, but tell your doctor if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea| .
Fever and chills If you develop a fever or chills let your doctor know.
Sore eyes Your eyes may become sore, red and itchy. This is known as conjunctivitis. Your doctor can prescribe eye drops.
This section has been compiled using information from a number of reliable sources including:
For further references, please see the general bibliography| .
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