Treatment Name: Cetuximab (Erbitux®)
Cetuximab (Erbitux®) is an Immunotherapy Regimen for Head and Neck Cancer
How does cetuximab work?
Cetuximab is designed to kill and slow growth of cancer cells. Cetuximab binds to receptors, called EGFR (epidermal growth factor receptor), located on the surface of cancer cells that signal the cell to divide and make more. Cetuximab does not stop normal cells from reproducing.
Goals of therapy:
Cetuximab is given to shrink tumors and alleviate symptoms of head and neck cancer. Cetuximab is not commonly given with the goal of cure.
- Cetuximab intravenous infusion (I.V.) over two hours on Cycle 1
- Cetuximab I.V. over one hour on Cycle 2 and beyond
Estimated total infusion time for this treatment:
- Up to three hours for Cycle 1 due to pre-medications and assessment for infusion reactions; as short as 90 minutes for Cycle 2 and beyond
- If a patient’s blood levels of magnesium or potassium are low and need replacement by IV infusion this could extend time in the clinic by two or more hours, bringing the total time to nearly four 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
Click here for common starting doses
Cetuximab is usually given in an outpatient infusion center, allowing the person to go home afterwards.
Cetuximab is repeated every once every 7 days. This is known as one Cycle. Each cycle is repeated until the drug no longer works or if unacceptable side effects occur.
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 side effects with cetuximab are shown here. Many of these side effects are experienced because cetuximab is given with radiation in this treatment.
- Skin reaction (94%)
- Mouth sores (94%)
- Trouble swallowing or pain while swallowing (63%)
- Dry mouth (71%)
- Skin rash, acne-like (10%)
- Infusion reactions- fever, chills, shortness of breath (2%)
Side effect videos
How often is monitoring needed?
A physical exam and labs (blood tests) may be checked before treatment and periodically during treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), blood magnesium and potassium levels, and complete blood count (CBC), plus any others your doctor may order.
How often is imaging needed?
Imaging may be checked before treatment and periodically during treatment. Imaging may include: computerized tomography (CT) scans and magnetic resonance imaging (MRI).
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue cetuximab as planned, or delay or switch therapy.
- The first dose of cetuximab is the most likely to have an infusion reaction, which includes: 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 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. 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 will receive an antihistamine such as diphenhydramine (Benadryl®) to help prevent 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. These infusions can increase your time at the infusion center by one to four hours depending on the dose
- 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 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 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 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 Cetuximab (Erbitux®)