Irinotecan and cetuximab
Irinotecan and cetuximab chemotherapy is a treatment used to treat advanced bowel cancer.
This information should ideally be read with our general information about chemotherapy and your type of cancer.
The drugs used in this treatment are:
Irinotecan (Campto ®) - a chemotherapy drug
Cetuximab (Erbitux ®) - a monoclonal antibody drug.
Monoclonal antibodies are sometimes called targeted therapies. They work by ‘targeting’ specific proteins (receptors) on the surface of cells and stopping them from stimulating the cancer cells to divide and grow.
How irinotecan and cetuximab are given
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You usually have treatment in the chemotherapy day unit or during a short stay in hospital. A chemotherapy nurse will give it to you. During treatment, you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.
You will also see a doctor or nurse before you have chemotherapy. They will ask you about how you have been. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Your nurse will give you anti-sickness drugs as an injection into a vein or as tablets. You will also be given some other drugs to help reduce side effects during treatment. Your nurse will give you these drugs and the chemotherapy through one of the following:
a short thin tube (cannula) that the nurse puts into a vein in your arm or hand
a fine tube that goes under the skin of your chest and into a vein close by (central line)
a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
Your nurse will give you cetuximab as a drip into your vein. They usually run the drip through a pump, which gives you the drug over a set time. This is usually between one and two hours. An hour after the cetuximab finishes the nurse will give you irinotecan as a drip. This is given over 90 minutes the first time you have it but after this can be given over 30 minutes.
When the chemotherapy is being given
Some people might have side effects while they are having the chemotherapy:
Cetuximab may cause an allergic reaction while it’s being given. This is more common with the first treatment, so it’s given slowly. The nurse will give you drugs to help prevent or reduce a reaction. They will check you for signs of a reaction while the drip is running and for an hour afterwards. If you have a reaction, they will treat it quickly.
Signs of a reaction can include: flu-like symptoms (headaches, a high temperature or chills); feeling sick; a rash; feeling itchy; breathlessness; having pain in your back, tummy or chest; or feeling unwell. Tell your nurse straight away if you have any of these symptoms.
Rarely, a reaction can happen a few hours after treatment. If you develop any of these symptoms or feel unwell after you get home, contact the hospital straight away for advice.
Irinotecan reaction (acute cholinergic syndrome)
Some people may have side effects within 24 hours of having irinotecan. These include diarrhoea, tummy cramps, sweating more than usual or producing a lot of saliva.
This is called acute cholinergic syndrome and it can usually be prevented or controlled by a drug called atropine. Your nurse gives you atropine as an injection under the skin (subcutaneously). Tell your doctor or nurse if you have any of these symptoms.
Your course of irinotecan and cetuximab
You have chemotherapy as a course of several sessions (or cycles) of treatment over a few months. Each cycle of irinotecan and cetuximab usually takes either 14 days (two weeks) or 21 days (three weeks).
If you have it on a 14-day cycle, you have irinotecan and cetuximab on the first day of treatment and then a break with no treatment for 13 days.
If you have it on a 21-day cycle, you have irinotecan and cetuximab on the first day of treatment. You then have cetuximab again on days eight and 15. After this, you have a break with no treatment for six days. This takes you to day 21.
At the end of either the 14 or 21 days, you start your second cycle of irinotecan and cetuximab. This is exactly the same as the first cycle. Your doctor or nurse will tell you the number of cycles you are likely to have and whether you will have a 14- or 21-day cycle.
Before you go home, the nurse or pharmacist will also give you anti-sickness drugs to take. They may also give you anti-diarrhoea tablets if you need them. Take all your tablets exactly as your nurse or pharmacist has explained.
Possible side effects of irinotecan and cetuximab
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We explain the most common side effects of irinotecan and cetuximab here. But we don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention but you are very unlikely to get all of them. Always tell your doctor or nurse about the side effects you have.
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 means they will be more likely to work better for you. Your nurse will give you advice about managing your side effects. After your treatment is over, the side effects will start to improve.
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.
Risk of infection
Chemotherapy can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia.
Contact the hospital straight away on the contact number you’ve been given if:
your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
you suddenly feel unwell, even with a normal temperature
you have symptoms of an infection – this can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
The number of white blood cells usually increases steadily and returns to normal before your next treatment. You will have a blood test before having more chemotherapy. If your white blood cells are still low, your doctor may delay your treatment for a short time.
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin. Some people may need a drip to give them extra platelets.
Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells (blood transfusion).
This may happen more than 24 hours after the treatment and can sometimes be severe. If you get diarrhoea, take the anti-diarrhoea drugs you were given straight away. It’s important to take them exactly as your nurse or pharmacist explained and follow any other advice you were given. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
If the drugs don’t work quickly or you still have diarrhoea after 24 hours, contact the hospital straight away on the numbers your nurse gave you. Some people may need to go to hospital to have fluids through a drip (infusion) or you may need antibiotics.
You may get pain or discomfort in your tummy (abdomen), feel bloated or have indigestion or wind. Your doctor can prescribe drugs to help improve these symptoms. Tell them if the pain doesn’t improve or gets worse.
This may happen in the first few days after chemotherapy. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains to you. It’s easier to prevent sickness than to treat it after it has started.
If you still feel sick or are vomiting, contact the hospital as soon as possible. They can give you advice and change the anti-sickness drug to one that works better for you.
Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after it’s finished. 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.
Chemotherapy may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. This treatment can cause a rash, which may be itchy.
Cetuximab can cause more severe skin changes, including reddening of the skin, red pimples and spots on the face (acne). Always tell your doctor or nurse about any skin changes. They can give you advice and prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
During treatment and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than usual. You can still go out in the sun, but use a suncream with a sun protection factor (SPF) of at least 30, and cover up with clothing and a hat.
You usually lose all the hair on your head. Your eyelashes, eyebrows and other body hair may also thin or fall out. This usually starts after your first or second cycle of chemotherapy. It is almost always temporary and your hair will grow back after chemotherapy ends. It is important to cover your head to protect your scalp when you are out in the sun until your hair grows back. Your nurse can give you advice about coping with hair loss.
Your eyes may become watery and feel sore. Your doctor can prescribe eye drops to help with this. If your eyes get red and inflamed (conjunctivitis), tell your doctor. This is because you may need antibiotic eye drops. Rarely, cetuximab may affect your vision. Always tell your doctor or nurse if you have eye pain or notice any change in your vision.
Muscle and/or joint pain
You may get pain in your joints or muscles for a few days after chemotherapy. Tell your doctor if this happens so they can prescribe painkillers. Let them know if the pain does not get better. Try to get plenty of rest. Taking regular warm baths may help.
Changes in the way the liver works
Chemotherapy may affect how your liver works. This is usually mild and goes back to normal after treatment. You will have blood tests to check how well your liver is working.
Reduced levels of magnesium and potassium
Cetuximab can sometimes affect the levels of magnesium and potassium in your blood. You will have regular blood tests and your doctor may prescribe supplements to take if the levels are too low.
Less common side effects of irinotecan and cetuximab
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Changes in the way the heart works
The drugs can affect the way the heart works. You may have tests to see how well your heart is working before, during and sometimes after treatment.
If you have pain or tightness in your chest, feel breathless or notice changes to your heartbeat at any time during or after treatment, tell a doctor straight away.
Effects on the lungs
Cetuximab can cause changes to the lungs. Always tell your doctor if you develop wheezing, a cough, a fever or feel breathless. You should also let them know if any existing breathing problems get worse. If necessary, they can arrange for you to have tests to check your lungs.
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 here.
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Blood clot risk
Cancer increases the chance of a blood clot (thrombosis) and chemotherapy can add to this. A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Some medicines can interact with chemotherapy or be harmful when you are having chemotherapy. This includes medicines you can buy in a shop or chemist. Tell your doctor about any medicines you are taking, including over-the-counter drugs such as St Johns Wort, complementary therapies and herbal drugs.
Treatment may affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.
Your doctor will advise you not to become pregnant or to father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use effective contraception during and for a few months after chemotherapy. You can talk to your doctor or nurse about this.
If you have sex within the first couple of days of having chemotherapy you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluid.
Changes to your periods
Chemotherapy can sometimes stop the ovaries working. You may not get a period every month and they may eventually stop. In some women, this is temporary, but for others it is permanent and they start the menopause.
Women are advised not to breastfeed during treatment and for a few months after. This is in case there is chemotherapy in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Give them contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
This section has been compiled using information from a number of reliable sources including:
electronic Medicines Compendium (eMC) medicines.org.uk (accessed July 2013).
Perry MC. The Chemotherapy Source Book. 5th edition. 2012. Lippincott Williams and Wilkins.
With thanks to: Bruce Burnett, Teacher Practitioner in Clinical Pharmacy Practice, who reviewed this edition.
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