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Cetuximab (Erbitux)

Cetuximab is a type of targeted cancer drug. It is also known by its brand name Erbitux. You might have it as a treatment for advanced bowel cancer and head and neck cancers that start in the mouth and throat.

How cetuximab works

This cancer drug quickly destroys dividing cells, such as cancer cells.

It is a type of monoclonal antibody. Monoclonal antibodies (MABs) are copies of a single antibody. They are made in the laboratory. Monoclonal antibodies seek out cancer cells by targeting particular proteins on the cell surface.

How you have cetuximab

You have cetuximab as a drip into your bloodstream. 

Into your bloodstream

You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

When you have cetuximab

You usually have cetuximab once a week. It takes about 2 hours the first time you have it. If you don’t have any problems, the following treatments take an hour.

How long you have cetuximab depends on your cancer type.

For advanced bowel cancer

You have cetuximab on its own or with other chemotherapy drugs. This usually continues for as long as it is helping you and the side effects aren’t too bad.

For head and neck cancer

You may have cetuximab every week, during your radiotherapy treatment. Or you may have it with chemotherapy, for as long as the treatment is helping you and the side effects aren’t too bad. 

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

We haven't listed all the side effects. It is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatment you are having. For example, your side effects could be worse if you are also having other drugs or radiotherapy.

This treatment affects the immune system. This may cause inflammation in different parts of the body which can cause serious side effects. They could happen during treatment, or some months after treatment has finished. In some people, these side effects could be life threatening.

When to contact your team

Your doctor or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects
  • your side effects aren’t getting any better
  • your side effects are getting worse

Common side effects

These side effects happen in more than 10 in 100 people (10%). You might have one or more of them. They include:

Low levels of magnesium in the blood

You might have low levels of magnesium in the body. This can cause muscular weakness and tremors. Your doctor will do regular blood tests to check for this.

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Inflammation

You may have some inflammation in the lining of the intestine, mouth and nose. This may cause your nose to bleed.

Mild allergic reaction

A reaction may happen during the infusion, causing a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills. Your nurse will give you medicines beforehand to try to prevent a reaction. Tell your nurse or doctor immediately if at any time you feel unwell. They will slow or stop your drip for a while.

Skin reaction

More than 8 out of 10 patients (80%) are likely to have a skin reaction with this drug. Some of these reactions are likely to be severe.

Most of these side effects happen in the first 3 weeks of starting treatment and disappear once the treatment is finished.

These side effects include:

  • acne
  • itching
  • dry skin
  • scaling of the skin
  • hair growth
  • nail changes

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (1 to 10%). You might have one or more of them. They include:

  • loss of fluid in your body (dehydration)
  • decrease in levels of calcium in the blood
  • loss of appetite and weight loss
  • inflammation of the eye which causes irritation and redness in the eye (conjunctivitis)
  • headache
  • loose or water stools (diarrhoea)
  • feeling and being sick
  • feeling tired
  • severe allergic reaction which can cause breathing difficulties, fainting, blood pressure changes and itchy skin

Rare side effects

These side effects happen in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

  • a blood clot starting in the deep veins of your body (deep vein thrombosis, DVT) that could possibly travel to your lungs (pulmonary embolism). This could be life threatening if not treated quickly
  • a blood clot starting in the lung (pulmonary embolism) which could be life threatening if not treated quickly
  • inflammation of the eye lid or front part of the eye. The eye may appear red or swollen
  • a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drinks

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Loss of fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Contraception and pregnancy

It is unknown whether treatment may or may not harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment.

Talk to your doctor or nurse about effective contraception you can use during treatment. Ask how long you should use it before starting treatment and after treatment has finished.

Breastfeeding

Don’t breastfeed during this treatment and for 2 months afterwards. The drug may come through in the breast milk.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)
  • be in contact with other people who have had live vaccines as injections

Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as oral polio or the typhoid vaccine.

This also includes the rotavirus vaccine given to babies. The virus is in the baby’s poo for up to 2 weeks and could make you ill. So avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.

You should also avoid close contact with children who have had the flu vaccine nasal spray if your immune system is severely weakened. 

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help

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