Treatment Name: Carboplatin + Fluorouracil + Cetuximab (Erbitux®)
Carboplatin + Fluorouracil + Cetuximab (Erbitux®) is a Chemotherapy Regimen for Head and Neck Cancer
How does carboplatin + fluorouracil + cetuximab work?
Carboplatin and fluorouracil are designed to kill rapidly dividing cancer cells or the slow growth of cancer cells. Cetuximab binds to a receptor called "EGFR" (Epidermal Growth Factor Receptor). When this receptor is located on the surface of cancer cells, cetuximab specifally targets this receptor to block its ability to tell the cancer cell to grow and divide. Cetuximab does not stop normal cells from reproducing. Cetuximab is commonly known as immunotherapy.
Goals of therapy:
Carboplatin + fluorouracil + cetuximab is given to shrink tumors and decrease symptoms of head and neck cancer. It is not commonly given with the goal of cure but is given to help patients live longer.
- Carboplatin intravenous (I.V.) infusion over one hour on Day 1
- Fluorouracil continuous I.V. infusion (via home-infusion pump) over 96 hours beginning Day 1 and ending on Day 5
- Cetuximab I.V. infusion over two hours on Day 1 of Cycle 1, then over one hour weekly starting one week after the first dose
Estimated total infusion room time for this treatment:
- When all medications are given on the same day: Up to 5 hours for Cycle 1, Day 1 if treatment is well tolerated. If the first treatment is tolerated well, infusion time can be as short as 3 hours for the first day of next cycles
- On days when just cetuximab is given, infusion time can take as little as 2 hours
- Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time
Carboplatin + fluorouracil + cetuximab is usually given in an outpatient infusion center, allowing the person to go home afterwards where they will continue to receive their continuous infusion of fluorouracil via ambulatory pump. On occasion, it may be given in the hospital if someone is too sick.
Carboplatin + fluorouracil + cetuximab is repeated every 21 days. This is known as one cycle. Each cycle may be repeated up to six times, depending upon the stage of the disease. Duration of therapy may last up to five months, depending upon response, tolerability, and number of cycles prescribed
Click here for the common carboplatin + fluorouracil + cetuximab starting doses
In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported carboplatin + fluorouracil + cetuximab side effects are shown here. These percentages reflect the amount of patients who experienced severe or life threatening side effects only:
- Low white blood cells (22%)
- Anemia [low red blood cells] (13%)
- Increased bruising or bleeding risk [low platelets; thrombocytopenia] (11%)
- Skin reaction (9%)
- Low blood potassium (7%)
- Vomiting (5%)
- Fatigue or weakness (5%)
- Loss of appetite (5%)
- Low blood magnesium (5%)
- Neutropenic fever (5%)
- Shortness of breath (4%)
- Pneumonia (4%)
- Low blood calcium (4%)
- Heart attack (3%)
- Heart failure (2%)
On average, 12% of patients discontinue treatment due to unacceptable side effects.
How often is monitoring needed?
Labs (blood tests) may be checked before each treatment and periodically in-between treatments at the discretion of your doctor. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order.
How often is imaging needed?
Imaging may be checked before treatment and every 6 weeks until the end of treatment. Imaging may include: X-rays, magnetic resonance imaging (MRI) or computerized tomography (CT) scans
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue carboplatin + fluorouracil + cetuximab as planned, delay treatment, or switch therapy if it is no longer helping to achieve your goals.
- Patients will have an infusion pump strapped to their body for 2 days to allow fluorouracil (5-FU) to continuously infuse into a vein. After receiving carboplatin and cetuximab, the I.V. line for fluorouracil is then connected by a nurse and the patient may go home. When the four-day fluorouracil infusion is finished, the patient goes back to the infusion center or hospital to have it disconnected, unless a home health nurse can come to the patient’s home to do this
- Fluorouracil may cause painful redness, blistering, and peeling skin reaction on the palms of your hands and on the soles of your feet. This is known as Hand-Foot Syndrome. Ways to help reduce the risk of experiencing Hand-Foot Syndrome include using a non-alcoholic moisturizer daily on your hands and feet, avoid wearing gloves, avoid prolonged exposure to hot water, and avoid activities that put pressure or friction on your hands and feet such as golf or tennis while receiving fluorouracil
- The first dose of cetuximab is the most likely to cause an infusion reaction, which may include: fever, shaking, chills, and shortness of breath; the incidence of this is very low, 2% or less. Even if medications are given beforehand this can happen. Side effects generally go away when the cetuximab is stopped. It may be restarted at a slower rate. Most patients are still able to receive the entire dose, although it may take longer than expected
- Development of a skin rash is common while on cetuximab however, development of skin rashes may be linked with better disease response from cetuximab. Mild skin rashes can be treated with topical or oral antibiotics that are prescribed by your doctor. More severe rashes may be able to be treated with oral medications. Tell your doctor about any skin reactions
- Avoid excess sun exposure while receiving cetuximab and up to 2 months after the last dose
- Before each infusion, you may receive an antihistamine such as diphenhydramine (Benadryl®) to help prevent infusion reactions
- Cetuximab may decrease your blood levels of potassium and/or magnesium. You may need to receive fluids into the vein containing magnesium and potassium or take these electrolytes in pill form
- Cetuximab may cause changes to fingernails and toenails such as redness, swelling, oozing, bleeding, cracking, discoloration, or ridges in the nails. This is known as “paronychia”. This can first develop weeks or months after starting therapy with cetuximab and can last for months after therapy is stopped. To help prevent paronychia from developing, avoid wearing tight fitting shoes or gloves and avoid putting unnecessary pressure or friction on fingernails and toenails. If you experience symptoms of paronychia, talk with your doctor as prescription corticosteroid creams or antibiotics may be needed
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for head and neck cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Carboplatin + Fluorouracil + Cetuximab (Erbitux®), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Carboplatin + Fluorouracil + Cetuximab (Erbitux®). Depending upon your income, they may be able to help cover the cost of:
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Carboplatin + Fluorouracil + Cetuximab (Erbitux®) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.
What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.
Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.
Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.
Learn more about pursuing emotional wellness while receiving treatment with Carboplatin + Fluorouracil + Cetuximab (Erbitux®)
What is Head and Neck Cancer?
A group of diseases of cells found in the mouth, lip, nasal cavity, throat, sinuses, and lymph nodes in the neck. Head and neck cancer is a rare condition. Known causes of head and neck cancer are strongly related with lifestyle and environmental risk factors including: tobacco use, alcohol consumption, UV light (sun exposure), certain strains of viruses (Epstein Barr virus [EBV] and human papilloma virus [HPV]), exposure to certain chemicals in the workplace, and vitamin A deficiency. If detected early it is highly curable. The stage of head and neck cancer can vary at diagnosis and throughout treatment. Stages of head and neck cancer include the Tumor, Node, Metastatis (TNM) staging system to describe a different area of cancer growth. After that is known, Stage Grouping using Stages I, II, III, or IV is assigned. This describes the extent of cancer throughout the body. The effectiveness of the treatment may depend upon the stage at diagnosis.
NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.
What does Cure mean?
The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, doctors use the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.
Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.
Common Carboplatin + Fluorouracil + Cetuximab Starting Doses
- Carboplatin AUC = 5 intravenous infusion (I.V.) over 1 hour on Day 1
- Fluorouracil 1000 mg/m2 I.V. over 24 on Days 1, 2, 3, and 4
- Cetuximab 400 mg I.V. over two hours on Day 1 of Cycle 1, then over one hour once weekly starting one week after the first dose
If you are interested in reading the clinical trials results, please click on references below:
Vermorken JB, Mesia R, Rivera F, et al. Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med 2008;359:1116-1127.
What is a CBC?
A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.
2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.
3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.
What is a CMP?
A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status, 2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.
Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein
13) Serum glucose
14) Serum calcium