Cetuximab (Erbitux®) is used to treat advanced cancer of the bowel (colon and rectum) or cancer of the head and neck. It may also be used to treat other types of cancer as part of a research trial.
It’s best to read this information with our general information about the type of cancer you have. During treatment, you will see a cancer doctor and a cancer nurse.This is who we mean when we mention doctor or nurse in this information.
Cetuximab belongs to a group of cancer drugs known as monoclonal antibodies. These drugs are sometimes called targeted therapies. They work by ‘targeting’ specific proteins (receptors) on the surface of cells.
Certain cancer cells 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 chemotherapy and radiotherapy.
When it’s used to treat bowel cancer, cetuximab only works on bowel cancers that have a normal RAS gene. Doctors will test the cancer cells before treatment to see if there are changes (mutations) in this gene.
When cetuximab is used
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Cetuximab can be used in certain situations to treat bowel cancer that has spread (advanced). You usually have it as well as chemotherapy.
It can also be used to treat some cancers of the head and neck that have started to spread into surrounding tissue (locally advanced). It is usually given with radiotherapy but can also be given with chemotherapy.
Cetuximab may only be available in some situations. Your cancer doctor can tell you if it's appropriate for you. Some people may be given it as part of a clinical trial.
If a drug isn’t available on the NHS, there may be different ways you are still able to have it. Your cancer doctor can give you advice. We have further information on what to do if a treatment isn’t available.
How cetuximab is given
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A nurse gives you cetuximab into a vein as a drip (intravenous infusion). Or, you may have it through a small infusion pump. You have the first treatment slowly, over about two hours. Afterwards you stay in the clinic for about an hour, so the nurses can check to make sure you don’t have a reaction to the drug. If you are having chemotherapy on the same day, you usually have it an hour after cetuximab. You usually have cetuximab once a week, or every two weeks.
Possible side effects of cetuximab
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We have included the most common side effects of cetuximab here. We haven’t included all of the less common and rarer side effects. You may get some of the side effects we mention, but you will not get them all.
If you have chemotherapy or radiotherapy along with cetuximab some side effects may be worse. You may also have side effects not listed here. We have more information about chemotherapy and radiotherapy.
Your doctor can prescribe drugs to help control some side effects. It is very important to take them exactly as your nurse or pharmacist has explained. This will help the drugs work as well as possible for you.
Your nurse will give you advice about managing side effects. After your treatment is over, side effects will start to improve. Always tell your doctor or nurse about the side effects you have.
Serious and life threatening side effects
Sometimes cancer drugs can result in very severe allergic reactions, which rarely may be life threatening. Your cancer doctor and nurse can explain the risk of these side effects to you.
Side effects during treatment
Some people have an allergic reaction to cetuximab. This can happen when it is given or for up to an hour afterwards. You will be given drugs before the infusion to reduce the chance of a reaction happening. A reaction is usually mild but, rarely, can be more severe. If you have a reaction, the nurses can usually treat this by slowing or stopping the drip. You’ll have the rest of your treatments given at a slower rate.
You’ll be checked closely during treatment. But always tell your nurse or doctor if you feel unwell or have any of the following symptoms:
flu-like symptoms, such as a 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 suddenly finding it hard to breathe
tight chest or chest pain.
Rarely, people may get a reaction 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.
You are more likely to have a serious allergic reaction to cetuximab if you have:
an allergy to red meat
an allergy to tick (tiny spider-like insect found in woodland and heath areas) bites.
If you have either of these you must tell your cancer doctor and nurse before they give you cetuximab. The risk of having a severe allergic reaction in these situations is much greater.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice any time of day or night. Save these numbers in your phone or keep them somewhere safe.
More information about this drug
We’re not able to list every side effect for this treatment here, particularly the rarer ones. For more detailed information you can visit the electronic medicines compendium.
You may develop an acne-like rash on the face, neck and body during the first three weeks of treatment. Your doctor can prescribe treatment to reduce the rash.The skin may also become dry, itchy and flaky. These side effects usually improve when treatment finishes.
If you have severe skin problems, your doctor may lengthen the time between treatments or lower the dose of cetuximab.
Very rarely, people may have a very severe skin reaction. The symptoms can include large blisters, peeling skin and sores in your mouth. You may also have a fever (high temperature). You must contact the hospital straight away if this happens as it may cause very serious problems.
Always tell your doctor or nurse about any skin changes. They can give you advice and prescribe creams for your skin or medicines to help. If you have severe skin problems they may lengthen the time in between your treatments or lower the dose.
Here are some tips:
Wash with tepid water using mild, unperfumed, soap-free cleansers
Moisturise your skin regularly with unperfumed moisturisers – ask your doctor or nurse what’s best
Don’t use anti-acne products or any products containing alcohol on your skin
Wear sunscreen with sun protection factor (SPF) of at least 30 when in the sun, and cover up with clothing or a hat.
Feeling tired is a common side effect of cetuximab, especially towards the end of treatment and for some weeks after it’s over. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
Your doctor can prescribe effective anti-sickness drugs to prevent or reduce sickness or vomiting. If the sickness isn't controlled, or if it continues, tell your doctor as they can prescribe other anti-sickness drugs that may work better for you.
Cetuximab can cause diarrhoea. This can usually be easily controlled with medicine but tell your doctor if it is severe or continues. If you have diarrhoea it’s important to drink plenty of fluids to stop you becoming too dry (dehydrated).
Sore mouth and nose
The lining of your mouth and nose may become sore. You may have mouth ulcers or nosebleeds.Tell your nurse or doctor if you have any of these changes, They can give you medicines to help. Clean your teeth and/or dentures morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse can give you advice on looking after your mouth.
These are less common than skin changes, but sometimes develop after three months or more. Your eyelashes may grow longer and curlier. You may notice that your head and body hair is finer, curlier or more brittle. Men may notice they have less beard growth. A few people have hair loss which may develop gradually over several months. These changes usually improve when treatment is over.
You may notice changes to your nails. They may become brittle and break easily. Wear gloves when washing dishes or using detergents to help protect your hands and nails. If the area around your nails becomes inflamed tell your doctor straight away.
If you have headaches let your doctor or nurse know. They can give you painkillers to relieve this.
Cetuximab may makes your eyes feel dry, sore, red and itchy. Let your doctor know so they can prescribe soothing eye drops if necessary. If these don’t improve or you have changes to your vision or pain in the eye, tell your doctor. Less commonly, cetuximab may cause inflammation of the eyelid It’s important to contact your doctor straight away if this happens.
Treatment with cetuximab may cause changes in the way your liver works. This will return to normal when the treatment finishes. You're very unlikely to notice any problems, but your doctor or nurse will take regular blood samples to check your liver is working properly.
Reduced levels of magnesium in the blood
You will have regular blood tests to check this. Your doctor may prescribe you magnesium supplements if the levels are too low.
Rarely, cetuximab may cause a blood clot. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Let your doctor know if you become breathless or are more breathless than usual. Less commonly, cetuximab can cause a condition in which the lungs become inflamed. This can be very serious. It is more common in people of Japanese heritage. Contact the hospital straight away if you become suddenly breathless or your breathing gets worse.
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 doctor will advise you not to become pregnant or father a child while taking cetuximab, as not enough is known about its effect on the developing baby. It’s important to use effective contraception while having this drug. You can discuss this with your doctor or specialist nurse.
Women are advised not to breastfeed during treatment and for a few months after. This is in case there is any of the drug in their breast milk.
Doctors don’t yet know how cetuximab may affect the fertility of men and women. If you are worried about this, talk to your doctor before treatment starts.
Medical or dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are taking cetuximab. Tell them the name of your cancer doctor so they can ask for advice.
Always tell your dentist you are taking cetuximab.
This information has been compiled using a number of reliable sources, including:
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed June 2015).
Perry MC. The Chemotherapy Source Book. 5th edition. 2012. Lippincott Williams and Wilkins.
If you’d like further information on the sources we use, please feel free to contact us.
With thanks to Ooi Pak, Senior Pharmacist (Oncology/Haematology), who reviewed this edition.
Thank you to all of the people affected by cancer who reviewed what you're reading and have helped our information to grow.
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