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Cetuximab (Erbitux)
Ryan P. Smith, MD
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: February 22, 2004
Other Name: Erbitux (ER-bi-tux) (Imclone Systems, Inc. and Bristol-Myers Squibb Company)
| What it is used for: | ERBITUX (Cetuximab) has been approved by the U.S. Food and Drug Administration (FDA) as an Injection for use in combination with with irinotecan in the treatment of patients with EGFR-expressing, metastatic colorectal cancer who are refractory to irinotecan-based chemotherapy and for use as a single agent in the treatment of patients with EGFR-expressing, metastatic colorectal cancer who are intolerant to irinotecan-based chemotherapy. |
| How it works: | Erbitux is a monoclonal antibody that binds specifically to the epidermal growth factor receptor (EGFR). As the EGFR is abnormally over expressed in many cancers (including those of the colon and rectum), the inhibition of EGFR results in a decrease in tumor cell growth, and decreased production of other factors responsible for metastasis. Erbitux exerts its cancer fighting properties by competitively inhibiting the binding of epidermal growth factor to EGFR and hence not allowing cancer growth to occur. |
| How it is given: | Erbitux is administered intravenously, initially as a 120 minute infusion of a dose of 400 mg/m2. The recommended maintenance dose is 250 mg/m2, infused over 60 minutes. Normally, antihistamines are given prior to the administration of Erbitux. |
Side Effects and Precautions
Let your doctor or nurse know if you have any allergies and what medications you are currently taking, both prescription and over the counter medications. This includes vitamins, herbs, nutritional supplements and any recreational drugs. Not everyone experiences side effects and most side effects are temporary. Again, keep in mind that Erbitux will usually be given with irinotecan. Therefore, the side effects of Erbitux should be thought of with irinotecan in mind. The side effects that you may experience are:
Common Side Effects
Skin rash
Rash from Erbitux therapy occurred in 90% of patients, though severely in only 10% of patients. It is variable in presentation, ranging from dry skin to scaly, peeling skin, to a red, and sometimes itchy rash, with or without pustules.
What to do: Call your doctor or nurse if you develop a rash, itchy skin or blistering of the skin. Keep the areas clean. Your doctor may prescribe creams, ointments and pain medications if needed.
Fatigue
Fatigue is often multifactorial, with anemia often playing a role in the development of fatigue. Approximately half of the patients treated with Erbitux experienced fatigue, though it was only severe in 10%.
What to do: If severe fatigue develops, the most important thing to do is to ensure that there is not a serious underlying cause. This most commonly includes anemia, dehydration, malnutrition, or infection. These should all be investigated. In the meantime, common sense prevails, and activities should be curtailed somewhat so that you do not become exhausted or endanger yourself by performing strenuous activities.
Fever
A low-grade fever (and often its associated "run-down" feeling) occurred in one-third of patients treated with Erbitux alone. No patient had a high-grade fever associated with the administration of Erbitux.
What to do: Checking your temperature somewhat frequently is recommended, mainly to ensure that a high-grade fever does not develop which would presumably indicate a more serious infection. Acetaminophen, or other mild fever and pain reducing medications can be taken to relieve symptoms.
Gastrointestinal side effects
Nausea (29%), constipation (28%), and diarrhea (28%) all occurred in patients being treated with Erbitux alone. However, less than 3% had severe gastrointestinal symptoms.
What to do: Obviously nausea/vomiting
and diarrhea
is uncomfortable. However, the larger concern with these symptoms is the development of dehydration. To attempt to avoid this, take your anti-nausea or anti-diarrheal medications as prescribed. Try to drink 6-8 glasses of fluids a day. Avoid eating fatty foods, large meals, acidic foods (e.g. tomatoes, lemons, oranges, grapefruits) and spicy or hot foods when you feel nauseated. 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, as this could indicate dehydration. Constipation is also uncomfortable, yet rarely causes severe problems. A stool softener such as senna can be taken to avoid constipation. If severe, your physician may recommend a gentle laxative.
Again, it is noted that Erbitux will most often be administered concurrently with irinotecan. In these cases, fatigue was more common (73%), though again severe fatigue was only present in 16% of patients. Gastrointestinal side effects were also more common, with up to half of patients experiencing nausea, vomiting, and diarrhea. Again, however, though severe diarrhea was seen in up to one-quarter of patients, the remainder of the gastrointestinal side effects that were severe were uncommon. The skin toxicity seen with Erbitux alone continued to be seen with the addition of irinotecan.
Severe Infusion Reaction
During study, 3% of patients experienced a severe infusion reaction associated with the administration of Erbitux. Ninety percent of these were associated with the first infusion. These reactions were characterized by the rapid onset of airway obstruction, a hive-type rash, and a decrease in blood pressure. These severe reactions are treated with immediate epinephrine, steroids, and antihistamines with permanent discontinuation of Erbitux therapy.