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Cetuximab (Erbitux)

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This page tells you about the biological therapy cetuximab and its possible side effects. There are sections about

 

What cetuximab is

Cetuximab (pronounced see-tux-ee-mab) is a type of monoclonal antibody. Monoclonal antibodies are a type of biological therapy. Cetuximab is also known by its brand name, Erbitux. It is a treatment for advanced bowel cancer and cancer of the head and neck. You may also have it as part of trials for other types of cancer.

Some cancer cells have receptors called epidermal growth factor receptors (EGFR) on their surface. A protein produced naturally in the body called epidermal growth factor (EGF) attaches to the receptors. This triggers the cell to grow and divide into more cells. Cetuximab works by attaching itself to the EGF receptors. This blocks the EGF protein from reaching the cancer cells and stops them from growing.

Studies have shown that cetuximab does not work in people whose bowel cancer cells have a genetic change called a k-ras mutation. Around 4 out of 10 people (40%) with bowel cancer have a k-ras mutation. So doctors will test your tumour sample to see if you have a normal k-ras gene before starting treatment.

 

How you have cetuximab

Cetuximab is a liquid. You can have it as a drip through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

You have the first treatment over 2 hours. If this goes well you can have the next treatments over an hour. You have the treatment once a week. You are likely to have cetuximab alongside other treatments, such as chemotherapy drugs

If you have cetuximab in combination with other anti cancer drugs you will have them at least an hour after the end of the cetuximab drip. If you have cetuximab in combination with radiotherapy you usually start the cetuximab one week beforehand. 

The side effects associated with cetuximab are listed below. The effects may be different if you are having it with other drugs or with radiotherapy.

 

Common side effects

More than 10 in every 100 people have one or more of these.

  • Tiredness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
  • Some kind of skin reaction in more than 8 out of 10 people (80%) – this may be a rash similar to acne on your face, neck and trunk or your skin may be dry and itchy. More than 1 in 6 people (15%) have a severe skin rash
  • A mild effect on the liver – you are unlikely to notice any symptoms and your liver function will almost certainly go back to normal when treatment is finished. You will have regular blood tests to check how well your liver is working
  • Flu like symptoms occur in 3 out of 20 people (15%), including fever and chills – taking paracetamol can help
  • A sore mouth and throat
  • Increased hair growth
  • Infection of the skin around your nails
  • Loss of fertility – you may not be able to become pregnant or father a child after cetuximab treatment. It is important to talk to your doctor before starting treatment if you plan to have a baby in the future
  • A reaction to cetuximab during infusion, causing flu like symptoms such as a fever, chills and shivering (rigors), a headache and feeling sick. You will have anti allergy medicines beforehand to try to prevent a reaction. If you have a reaction, your nurse will slow your drip down or stop it for a while
 

Occasional side effects

Between 1 and 10 in every 100 people have one or more of the side effects listed below. 

A temporary drop in the number of blood cells made by the bone marrow, causing

  • An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
  • Bruising easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. Contact your hospital straight away if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other occasional side effects include

  • Watery, itchy, red eyes in 1 in 20 people (5%)
  • Blurred vision or eye pain
  • Diarrhoea – drink plenty of fluids. If your diarrhoea is severe or continues you could become dehydrated so let your doctor or nurse know
  • Low magnesium or calcium levels in your blood – you will have regular blood tests to check the levels
  • Loss of appetite and weight loss
  • Feeling sick – this is usually well controlled with anti sickness medicines
  • 1 in 50 people (2%) have a severe allergic reaction while having the treatment of an hour or so afterwards – let your doctor or nurse know straight away if you have wheezing, an itchy rash, chest pain or feel faint
 

Rare side effects

Fewer than 1 in 100 people have these effects.

  • Changes in lung tissue may lead to a cough or breathlessness
  • Blood clots in the leg – let your doctor or nurse know if you have any pain, redness or swelling in your legs
  • Blood clots in the lung – let your doctor or nurse know straight away if you have a sudden cough, breathlessness or chest pain
  • Soreness and redness of the eyelid
 

Important points to remember

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

  • How many times you've had the drug before
  • Your general health
  • The amount of the drug you have (the dose)
  • Other drugs you are having

Coping with side effects

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Other medicines

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.

Contraception

Cetuximab may have a harmful effect on a developing baby. It is important not to become pregnant or father a child during treatment and for a few months afterwards. Talk about contraception with your doctor or nurse before having the treatment.

Breastfeeding

Cetuximab may be present in breast milk so it is advisable not to breastfeed during treatment or for 2 months after the last dose.

 

Immunisations

You should not have immunisations with live vaccines while you are having treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your treatment. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.

 

More information on cetuximab

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.

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Updated: 18 September 2013