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®)
Individual Drug Label Information
- Cetuximab is an intravenous infusion given over one to two hours
- Severe infusion reactions such as difficulty breathing, low blood pressure, and heart problems can occur. You will receive medications before each dose of cetuximab to lower your risk of experiencing these reactions
- Heart attack (cardiac arrest) can occur due to blood electrolyte abnormalities. Your blood electrolytes (potassium, magnesium, and calcium) will usually be checked before each dose of cetuximab
- Dosage adjustments may be required for serious skin reactions or other toxicities
- Cetuximab does not have any drug interactions, but it does boost the effect of platinum drugs and radiation therapy
- Skin reactions, acne-like rash and dry skin
- Mouth sores
- Difficult swallowing, painful swallowing
- Dry mouth
- Throat pain
- Shortness of breath
- Weight loss
- Weakness and fatigue
- Decrease in blood magnesium, potassium, or calcium levels
- Click on the cetuximab (Erbitux) package insert below for reported side effects and possible drug interactions
Side Effect Videos
See DailyMed package insert.
Nausea and VomitingDiarrheaFatigue Pain
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1) Bonner JA, Harari PM, Giralt J, et al. Radiotherapy plus cetuximab for locoregionally advanced head and neck cancer: 5-year survival data from a phase 3 randomised trial, and relation between cetuximab-induced rash and survival. Lancet Oncol 2010;11:21-28.
2) Pinto C, Barone CA, Girolomoni G, et al. Management of Skin Toxicity Associated with Cetuximab Treatment in Combination with Chemotherapy or Radiotherapy. Oncologist. 2011;16:228-238.
Created: November 30, 2015 Updated: September 22, 2018
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.
Common Starting Doses
- Cetuximab 400 mg/m2 IV over 2 hours on Cycle 1, Day 1
- max IV rate 10 mg/min
- this is the loading dose 1 week prior to radiation therapy or completed 1 hr prior to platinum therapy with 5-FU (fluorouracil)
- Cetuximab 250 mg/m2 IV over 1 hour on Cycles 2 and beyond if well tolerated
- max IV rate 10 mg/min
- complete 1 hr prior to radiation therapy or platinum therapy with 5-FU (fluorouracil)
Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability
If you are interested in reading the clinical trials results, please click on references below:
Bonner JA, Harari PM, Giralt J, et al. Radiotherapy plus cetuximab for locoregionally advanced head and neck cancer: 5-year survival data from a phase 3 randomised trial, and relation between cetuximab-induced rash and survival. Lancet Oncol 2010;11:21-28.
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
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, 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.