Cetuximab (Erbitux®)

YYou usually have cetuximab at a day unit or clinic as an outpatient. You may have it on its own or with radiotherapy, chemotherapy or another targeted therapy, depending on the type of cancer you have.

During a course of treatment, you will meet someone from your cancer team, such as a:

• cancer doctor
• specialist nurse
• specialist pharmacist.

This is who we mean when we mention doctor, nurse or pharmacist in this information.

During your course of treatment, you will have regular blood tests. This is to check that it is safe for you to have treatment.

You will speak a doctor, nurse or pharmacist before you have treatment. They will talk to you about your blood results and ask how you have been feeling. If your blood results are okay, the pharmacy team will prepare your targeted therapy.

You have cetuximab as a drip into a vein (intravenous infusion). The nurse will run the infusion through a pump. This will give you the treatment over a set time. Your nurse will give your treatment through 1 of the following:

• a cannula – a short, thin tube the nurse puts into a vein in the arm or hand
• a central line – a fine tube that goes under the skin of the chest and into a vein close by
• a PICC line – a fine tube that is put into a vein in the arm and goes up into a vein in the chest
• an implantable port (portacath) – a disc that is put under the skin on the chest or arm and goes into a vein in the chest.

You have the first infusion over 2 hours and then stay in the clinic for about 1 hour after. This is to check you do not have a reaction to the drug. If you do not have any problems, your next treatment can be given at faster rate depending on dose.

You may have cetuximab once a week or every 2 weeks. How long you have it for depends on the type of cancer you have. If you are having it with other cancer drugs on the same day, you usually have cetuximab first.

If you are having it with other cancer drugs on the same day, you usually have cetuximab first.

Your cancer team will discuss your treatment plan with you. They may also give you anti-sickness drugs and other medicines to take home. Take all your capsules or tablets exactly as they tell you to.

Some people may have side effects while they are being given this treatment or shortly after they have it.

Some people have an allergic reaction to cetuximab. This can happen while having the infusion or for up to 1 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 it can be more severe. If you have a reaction, the nurses can usually treat it by slowing or stopping the infusion. You will then have the rest of your treatments more slowly.

Your nurse will check you for signs of a reaction during your treatment. Always tell them straight away if you feel unwell or have any of the following symptoms:

• feeling hot or flushed
• a skin rash
• itching
• shivering
• feeling dizzy
• a headache
• feeling breathless or wheezy
• swelling of your face or mouth
• pain in your back, tummy (abdomen) or chest. 

Rarely, some people have a reaction a few hours after treatment. If you have 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 cetuximb if you have an allergy to:

• red meat
• tick bites (a tick is a tiny spider-like insect found in woodland and heath areas).

You must tell your cancer doctor, nurse or pharmacist if you have either of these allergies before they give you cetuximab.

These side effects happen to less than 10 in 100 people (less than 10%) who have this treatment. Some of them are much rarer than this but they are still important to know about. Rare means a side effect that happens to less than 1 in 1,000 people (less than 0.1%).

This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is normal for you, or having watery or loose stools. You may also have stomach cramps. If you have a stoma, it may be more active than usual. 

If you are passing loose stools 3 or more times a day and this is not normal for you, contact the hospital as soon as possible on the 24-hour number. Follow the advice they give you about:

• taking anti-diarrhoea medicines 
• drinking enough fluids to keep you hydrated and to replace lost salts and minerals
• any changes to your diet that might help. 

They might also ask you for a specimen of your stool to check for infection.

Your doctor, nurse or pharmacist will prescribe anti-sickness drugs to help prevent or control sickness. Take the drugs exactly as they tell you to, even if you do not feel sick. It is easier to prevent sickness than to treat it after it has started.

If you feel sick, take small sips of fluid often and eat small amounts regularly. It is important to drink enough fluids. If you continue to feel sick, or if you are sick (vomit) 1 to 2 times in 24 hours, contact the hospital on the 24-hour number as soon as possible. They will give you advice. They may change your anti-sickness treatment. Let them know if you still feel sick.

Rarely, this treatment can cause a serious skin reaction that needs to be treated immediately in hospital. Contact the hospital straight away on the 24-hour number if you have any of these symptoms:

• a skin rash that is spreading 
• blistering or peeling skin
• flu-like symptoms, such as a high temperature and joint pain
• sores on your lips or in your mouth.

Feeling tired is a common side effect of this treatment. Try to pace yourself and plan your day so you have time to rest. Gentle exercise, like short walks, can help you feel less tired.

If you feel sleepy, do not drive or use machinery.

This treatment may cause hair changes. You may have some gradual hair loss a few months after treatment starts. You will not usually lose all the hair on your head.

You might also notice:

• a change in the texture or colour of your hair
• more hair growth on your face or chest 
• your eyelashes growing longer, or your eyebrows getting thicker. 

If you are having problems with hair changes, ask your cancer team for advice. Do not try to cut your eyelashes yourself. Your cancer team can arrange for an eye doctor to do this. 

Any hair changes usually go back to normal after treatment ends.

This treatment can affect your nails. They may grow more slowly or break more easily. You might notice ridges or white or dark lines across your nails. These changes usually disappear as the nails grow out after treatment. Sometimes nails can become loose or fall off. Tell your doctor, nurse or pharmacist about any changes to your nails.

If the skin around your nails becomes sore and swollen, contact the hospital straight away on the 24-hour number. These might be signs of an infection.

This treatment may make your eyes dry, sore, red and itchy. Your doctor, nurse or pharmacist can prescribe eye drops to help with this.

Contact the hospital on the 24-hour number if:

• your eyes do not improve after taking the eye drops
• you have changes to your vision such as, blurred vision
• you have pain in your eye, or they feel sensitive to light
• your eye or eyelid becomes red or inflamed or feels swollen.

This treatment may cause headaches. If you have headaches, tell your doctor, nurse or pharmacist. They can give you advice about painkillers that may help. Tell them if the headache does not get better, or gets worse.

This treatment can cause inflammation of the lungs. This is called pneumonitis. Contact the hospital straight away on the 24-hour number if you notice any of these changes during treatment or after it ends:

• breathlessness
• a cough that does not go away
• wheezing
• a fever, with a temperature over 37.5°C.

You should also tell them if any existing breathing problems get worse. You may have tests to check your lungs. You may need steroids or other treatments.

Rarely, this treatment can affect the way the heart works. This may be more likely if you are having it with other types of anti-cancer treatment. Your doctor can tell you more about this.

You may have tests to see how well your heart is working. These may be done before, during, and sometimes after treatment.

Contact a doctor straight away if you:

• breathlessness
• dizziness
• changes to your heartbeat (palpitations)
• swollen feet and ankles.

Other conditions can cause these symptoms, but it is important to get them checked by a doctor.

Always call 999 if you have:

• chest pain, pressure, heaviness, tightness or squeezing across the chest
• difficulty breathing.