Treatment Name: FOLFIRI + Cetuximab (Erbitux®)
FOLFIRI + Cetuximab (Erbitux®) is a Chemotherapy Regimen for Colon Cancer
How does FOLFIRI + cetuximab work?
Each of the chemotherapy drugs in FOLFIRI are designed to kill cancer cells. Cetuximab (an immunotherapy drug) is designed to bind to the surface of cancer cells and shut down one of the signals that tell the colon cancer cells to grow.
FOL – folinic acid (leucovorin)
F – fluorouracil (5-FU)
IRI –irinotecan (Camptosar®)
Goals of therapy:
FOLFIRI + cetuximab is given to shrink tumors and decrease symptoms of colon cancer and is not commonly given with the goal of cure.
How is FOLFIRI + cetuximab therapy for colon cancer given?
- Folinic acid (Leucovorin) intravenous infusion (I.V.) over two hours before fluorouracil on Day 1
- Fluorouracil (5-FU) I.V. push given over 3 to 5 minutes on Day 1
- Irinotecan I.V. infusion given over 90 minutes on Day 1
- Fluorouracil (5-FU) continuous I.V. infusion via home-infusion pump over 46 hours beginning Day 1 and ending on Day 3
- Cetuximab I.V. given over two hours on Day 1 of Cycle 1, then over one hour every week starting weekly after the first dose
Estimated total infusion time for this treatment:
- Up to 6 hours for Cycle 1, Day 1, when all medications are given on the same day. If the first treatment is tolerated well, infusion time can be as short as 5 hours for the first day of the next cycles
- On days when just cetuximab is given, infusion time can take as little as two hours
- Some doctors may choose to give cetuximab every two weeks, with the FOLFIRI part of the treatment, instead of weekly. This requires doubling the cetuximab dose. This may be chosen to decrease infusion center visits to just every two weeks
- 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
FOLFIRI + cetuximab is usually given in an outpatient infusion center, allowing the person to go home with an infusion pump, and then return to the infusion center in two days to get the pump disconnected. On occasion, FOLFIRI + cetuximab may be given in the hospital if someone is too sick.
FOLFIRI + cetuximab is repeated every 14 days. This is known as one Cycle. Each cycle may be repeated until the regimen no longer works or until unacceptable side effects occur. Duration of therapy depends upon response, tolerability, and number of cycles prescribed.
Click here for the common FOLFIRI + cetuximab starting doses.
What are the most common side effects from FOLFIRI + cetuximab for colon cancer?
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 serious drug side effects reported from FOLFIRI + cetuximab are shown here:
- Neutropenia [low white blood cells] (28%)
- All skin reactions (20%)
- Acne-like skin rash (16%)
- Diarrhea (16%)
- Fatigue (5%)
- Vomiting (5%)
- Infusion reaction (3%)
On average, 9% of patients discontinue treatment due to unacceptable side effects.
Watch videos on common FOLFIRI + cetuximab therapy side effects below
How often is monitoring needed?
Labs (blood tests) may be checked before each treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), blood magnesium, blood potassium, plus any others your doctor may order. CEA (carcinoembryonic antigen), a tumor marker, may be checked periodically.
How often is imaging needed?
Imaging may be checked before treatment and periodically during treatment. Imaging may include: magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans.
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue FOLFIRI + cetuximab as planned, reduce the dose of future treatments, delay the next dose until the side effect goes away, or switch to an alternative therapy.
What are the most important things to know about FOLFIRI + cetuximab while receiving treatment?
- Colorectal cancer patients will have an infusion pump strapped to their body for 2 days to allow fluorouracil (5-FU) to continuously infuse into a vein. The I.V. pump is connected at the end of the chemotherapy session by a nurse. When the infusion is finished (two days later) the patient will have to go back to the infusion center or hospital to have it disconnected, unless a home health nurse comes to the patient’s home to do this
- Diarrhea caused by irinotecan is commonly treated with atropine injections in the medical setting, both before and after the infusion. Diarrhea at home can affect quality of life and is commonly treated with loperamide (Imodium) purchased over-the-counter at a pharmacy. You may receive special instructions on how to use loperamide for diarrhea caused by irinotecan. Tell your doctor immediately of you have severe diarrhea at home or go to an emergency department immediately
- The first dose of cetuximab is the dose 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 (pre-meds) are given beforehand this can happen. Side effects generally go away when the infusion 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 this drug. 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 reactions. If possible, have someone drive you to and from these appointments as diphenhydramine can make you sleepy and have difficulty driving
- 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
- 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
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for colon cancer. Ask your doctor if any colon cancer 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 FOLFIRI + 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 FOLFIRI + Cetuximab (Erbitux®). Depending upon your income, they may be able to help cover the cost of:
- Folinic acid
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 FOLFIRI + 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 FOLFIRI + Cetuximab (Erbitux®)