Classification: monoclonal antibody
About Necitumumab (Portrazza™)
Necitumumab is a monoclonal antibody that binds specifically to the epidermal growth factor receptor (EGFR). EGFR is found on cancer cells. By binding to EGFR, necitumumab breaks down tumor cells.
How to Take Necitumumab
Necitumumab is administered intravenously (IV, or directly into a vein). The dose is typically 800mg and is given over 60 minutes on days 1 and 8 of a 3-week cycle. Patients may experience an infusion reaction including fever, chills or breathing problems. If you notice any changes in how you feel during the infusion, let your nurse know immediately.
Patients who have had infusion related reactions with prior infusions will receive pre-medication for subsequent doses. This medication may include diphenhydramine (Benadryl), acetaminophen (Tylenol), and dexamethasone. The infusion may be given slower if you are experiencing an infusion reaction.
Possible Side Effects of Necitumumab
There are a number of things you can do to manage the side effects of necitumumab. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:
Changes in Electrolytes
Electrolytes are minerals in your body that have many functions including regulating the amount of water in your body, the acidity of your blood and controling muscle function. Necitumumab can interfere with the levels of electrolytes in your body. The most common change is a decrease in the amount of magnesium (hypomagnesemia) in your body. Hypomagnesemia occurs starting around 6 weeks after starting treatment. Patients may also experience low calcium (hypocalcemia) and low potassium (hypokalemia). These changes can cause serious heart problems, including cardiac arrest (heart stopping).
Prior to each dose of necitumumab, and for at least 8 weeks following the completion of treatment, your labs will be drawn to check your electrolyte levels. You may receive electrolytes either orally (by mouth) or intravenously (directly into your vein) to regulate these levels. It is important to take these medications as directed.
Nail and Skin Changes
This medication has some unique nail and skin side effects that you may develop. Patients may develop a rash. While this rash may look like acne, it is not, and should not be treated with acne medications. The rash may appear red, swollen, crusty, dry and feel sore. You may also develop very dry skin, which may crack, be itchy or become flaky or scaly. The rash typically starts in the first week of treatment, but can occur at any time during treatment. Tips for managing your skin include:
- Use a thick, alcohol-free emollient lotion or cream on your skin at least twice a day, including right after bathing.
- Avoid sun exposure, as it can worsen the rash or cause a severe burn. Use a sunscreen with an SPF of 30 or higher and wear a hat and sunglasses to protect your head and face from the sun.
- Bathe/shower in cool or lukewarm (not hot) water and pat your skin dry.
- Use soaps, lotions and laundry detergents without alcohol, perfumes or dyes.
- Wear gloves to wash dishes or do housework or gardening.
- Drink plenty of water and try not to scratch or rub your skin.
- Notify your healthcare team if you develop a rash, as they can provide suggestions to manage the rash and/or prescribe a topical medication to apply to the rash or an oral medication.
- If you develop peeling or blistering of the skin, notify your healthcare team right away.
While receiving this medication, you may develop an inflammation of the skin around the nail bed/cuticle areas of toes or fingers, which is called paronychia. It can appear red, swollen or pus filled. Nails may develop "ridges" in them or fall off. You may also develop cuts or cracks that look like small paper cuts in the skin on your toes, fingers or knuckles. These side effects may appear several months after starting treatment, but can last for many months after treatment stops.
- Follow the same recommendations for your skin (above).
- Don't bite your nails or cuticles or cut the cuticles.
- Keep your fingernails and toenails clean and dry.
- You may use nail polish, but do not wear fake nails.
- Notify your doctor or nurse if any nails fall off or you develop any of these side effects or other skin abnormalities.
While receiving this medication, some patients may develop eye irritation or pain, changes in eyesight, dry or itchy eyes, or excess tears. Notify your healthcare team if you develop any eye pain, swelling, redness or any vision changes, including blurriness and sensitivity to light.
Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration.
Nausea and/or Vomiting
Talk to your doctor or nurse so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms.
Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.
Mouth Ulcers (Sores)
Certain cancer treatments can cause sores or soreness in your mouth and/or throat. Notify your doctor or nurse if your mouth, tongue, inside of your cheek or throat becomes white, ulcerated or painful. Performing regular mouth care can help prevent or manage mouth sores. If mouth sores become painful, your doctor or nurse can recommend a pain reliever.
- Brush with a soft-bristle toothbrush or cotton swab twice a day.
- Avoid mouthwashes that contain alcohol. A baking soda and/or salt warm water mouth rinse (2 level teaspoons of baking soda or 1 level teaspoon salt in an eight ounce glass of warm water) is recommended 4 times daily.
- If your mouth becomes dry, eat moist foods, drink plenty of fluids (6-8 glasses), and suck on sugarless hard candy.
- Avoid smoking and chewing tobacco, drinking alcoholic beverages and citrus juices.
Blood Clots, Heart Attack and Stroke
This medication can increase the risk of blood clots, stroke and heart attack. If you experience symptoms of these problems, you should contact your healthcare provider immediately or go to an emergency room. Symptoms can include: swelling, redness or pain in an extremity, chest pain or pressure, pain in your arm, back, neck or jaw, shortness of breath, numbness or weakness on one side of the body, trouble talking, confusion or mental status changes.
Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment and for at least 3 months after treatment. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should not breastfeed while taking this medication and for at least 3 months after completion of treatment.