Erbitux
Erbitux (cetuximab) is a type of targeted anticancer treatment for head and neck cancer (involving the mouth; nose and throat; or mouth and throat), as well as colon or rectal cancer. It can be used by itself, in combination with other anticancer medications, or in combination with radiation. Erbitux (cetuximab) is given as an infusion through the vein by a healthcare provider. It’s a recommended treatment option for certain adults, but can commonly cause bothersome skin rashes.
What is Erbitux (cetuximab)?
What is Erbitux (cetuximab) used for?
- Head and neck cancer in certain adults
- Colorectal cancer in certain adults
How Erbitux (cetuximab) works
Erbitux (cetuximab) is a monoclonal antibody that acts as an epidermal growth factor receptor (EGFR) inhibitor. It blocks certain proteins from attaching to a specific target on cells called the epidermal growth factor receptor (EGFR). EGFR is found on both normal and cancer cells, and is important for cell growth. Cancer cells usually have more EGFR proteins than normal cells. When EGFR is blocked by Erbitux (cetuximab), cancer cells can’t grow and spread as well.
Drug facts
Side effects of Erbitux (cetuximab)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Acne-like rash (up to 95%)
- Fatigue or weakness (up to 91%)
- Diarrhea (up to 72%)
- Nausea (up to 64%)
- Dry skin (up to 57%)
- Itching (up to 47%)
- Vomiting (up to 40%)
*Some side effects listed above might not be from Erbitux (cetuximab) alone, since some studies included people receiving Erbitux (cetuximab) with radiation or other anticancer medications.
Less Common Side Effects
- Changes in the appearance of your nails
- Headache
- Cough
- Fever
- Lack of appetite or weight loss
- Dehydration
- Constipation
- Heartburn
- Dry mouth
- Changes in taste
- Tingling or numbness in arms or legs
- Sore throat or mouth
- Difficulty breathing
- Difficulty sleeping
- Mood changes
- Pain (stomach, joint, muscle, bone, or general pain)
Erbitux (cetuximab) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Serious infusion reactions: throat tightness, trouble breathing, cough, itching or hives, flushing, swelling, chest pain, fast heartbeat, dizziness, fainting
- Heart attack: chest pain, arm pain, fast or irregular heartbeat, shortness of breath, dizziness, cold sweat, sudden collapse
- Severe skin reactions: painful blisters, skin wounds, peeling skin, painful sores in your mouth or around your eyes
- Infections: repeated fevers, chills, cough, trouble breathing, severe diarrhea, vomiting, painful or frequent urination
The following Erbitux (cetuximab) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:
More common
Blemishes on the skin or pimples
bloating or swelling of the face, arms, hands, lower legs, or feet
body aches or pain
chills
congestion
deep cracks, grooves, or lines in the skin
difficult or labored breathing
dizziness
headache
hoarseness
lower back or side pain
painful or difficult urination
pale skin
rapid weight gain
severe dry skin
skin rash
tender, swollen glands in the neck
tightness in the chest
tingling of the hands or feet
trouble with breathing on exertion
trouble with swallowing
unusual bleeding or bruising
unusual tiredness or weakness
unusual weight gain or loss
voice changes
vomiting
Less common
black, tarry stools
confusion
decreased urination
fainting
fast heartbeat
increase in heart rate
lightheadedness
rapid, shallow breathing
sores, ulcers, or white spots on the lips or in the mouth
sunken eyes
thirst
wrinkled skin
Incidence not known
Blistering, peeling, or loosening of the skin
cracked lips
difficulty in swallowing
joint or muscle pain
red, irritated eyes
red skin lesions, often with a purple center
stiff neck or back
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Belching
burning, dry, or itching eyes
difficulty having a bowel movement
discharge from the eye
discoloration of the fingernails or toenails
discouragement
excessive tearing
feeling sad or empty
hair loss or thinning of the hair
indigestion
irritability
lack or loss of appetite
lack or loss of strength
loss of interest or pleasure
redness, pain, or swelling of the eye, eyelid, or inner lining of the eyelid
stomach discomfort, upset, or pain
swelling or inflammation of the mouth
trouble concentrating
trouble sleeping
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Erbitux (cetuximab)
Pros
- Recommended treatment option for head and neck cancers and colorectal cancers in certain adults
- More precise in the way it targets cancer cells, compared to traditional chemotherapy
- Can be given every week or every other week, depending on the regimen or preference
Cons
- Requires visits to the clinic or infusion center to receive your dose
- Takes 1 to 2 hours to receive each infusion
- Might require an additional hour or more of observation after each infusion to monitor for any reactions
Pharmacist tips for Erbitux (cetuximab)
- You might experience an infusion or allergic reaction during or shortly after your Erbitux (cetuximab) infusion, some of which can be life-threatening. Let your provider know or get help right away if you experience any trouble breathing, hives, flushing, chest pain, skin turning blue, fast heartbeat, or dizziness.
- You’ll be given an antihistamine, like diphenhydramine (Benadryl), 30 to 60 minutes before the first dose of Erbitux (cetuximab) to lower the risk of infusion reactions. This ”premedication” can also be given before your following doses if necessary.
- Erbitux (cetuximab) can commonly cause an acne-like rash. This usually happens within 2 weeks of starting Erbitux (cetuximab) and can last more than a month after stopping treatment. Let your provider know if it’s bothersome. Topical corticosteroids or oral antibiotics can help improve milder symptoms. For more severe cases, your provider might lower your dose or have you stop treatment.
- Being out in the sun and getting exposed to ultraviolet (UV) rays can make skin problems worse while receiving Erbitux (cetuximab). Avoid direct exposure to the sun and tanning beds during treatment and for 2 months after your last dose. If you’re going to be outside, be sure to wear sunscreen with at least sun protective factor (SPF) 15 and protective clothing like long sleeves, pants, hats, and sunglasses.
- If you’re a woman who can get pregnant, you should use birth control while receiving Erbitux (cetuximab) and for 2 months after the last dose. This medication might cause harm to an unborn baby.
Common questions about Erbitux (cetuximab)
Erbitux (cetuximab) targets EGFR, which is a protein that’s found not only on cancer cells, but also on normal cells, especially skin cells. When EGFR is blocked in normal skin cells, the signal for these cells to grow normally is affected. It can trigger an immune response, which can cause changes to your skin, such as rashes and inflammation. It can also affect how well your skin can hold moisture, leading to dryness and cracking. Let your provider know right away if you experience any painful blisters, skin wounds, peeling skin, painful sores in your mouth or around your eyes. These can be signs of a more serious skin reaction and might require stopping Erbitux (cetuximab).
You should receive Erbitux (cetuximab) treatment as instructed by your provider. This medication is usually given every week or every other week during each chemotherapy cycle, so it’s important to follow the schedule your provider gives you. How long you receive Erbitux (cetuximab) therapy depends on several factors, including how well the medication is working to treat your cancer, your chemotherapy regimen, and how well you tolerate it. Don’t stop receiving Erbitux (cetuximab) without first discussing with your provider.
Possibly. It depends on how severe your reaction was. Your provider should discuss with you the risks and benefits of treatment with Erbitux (cetuximab) again following an infusion or allergic reaction. People who’ve experienced such reactions to Erbitux (cetuximab) can be given antihistamines before future infusions. Your provider can also slow down how fast you receive the infusion through your vein to try and prevent reactions. Talk to your provider if you’re concerned about receiving this treatment.
Erbitux (cetuximab) might cause harm to your unborn baby and isn’t recommended for use in pregnancy, unless your provider thinks the benefit is greater than the risk for both you and your unborn baby. If you’re a woman of childbearing age, you should use birth control while receiving Erbitux (cetuximab) and for 2 months after the last dose. Let your provider know right away if you become pregnant while receiving Erbitux (cetuximab).
Erbitux (cetuximab) isn’t recommended while breastfeeding. We don’t know if it can pass into breast milk, but there’s a risk of serious harm to nursing infants if it in fact does. Because of this risk, you shouldn’t breastfeed during Erbitux (cetuximab) treatment and for 2 months after your last dose. Talk with your provider if you have any questions about breastfeeding while receiving Erbitux (cetuximab).
Erbitux (cetuximab) is a type of protein called a monoclonal antibody. It’s made in a lab using combined genetic material from humans and mice. Monoclonal antibodies work similarly to your body’s natural antibodies. They can recognize and target specific proteins on cancer cells to act like or boost an immune response. In particular, Erbitux (cetuximab) targets epithelial growth factor receptor (EGFR) and prevents proteins from attaching to the receptor on cancer cells. This prevents cancer cells from growing and spreading.
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Risks and warnings for Erbitux (cetuximab)
Erbitux (cetuximab) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Infusion or allergic reactions
- Risk factors: History of tick bites | Allergy to red meat | Having certain antibodies
Erbitux (cetuximab) can cause infusion or allergic reactions, which can be serious. Severe infusion reactions can happen at any time, but most commonly occur with the first infusion. These reactions can happen during or several hours after the infusions. Your risk for allergic reactions, including anaphylaxis, might be higher if you have a history of tick bites, allergy to red meat, or have certain antibodies in your system. There’s a test available to see if you have these antibodies, so your provider can decide if this medication is safe for you to take.
Contact your provider or get medical help right away if you experience any throat tightness, trouble breathing, wheezing, fever, chills, hives, flushing, chest pain, fast heartbeat, dizziness, or fainting.
Heart attack
- Risk factors: Heart problems
Rare cases of heart attack or other heart complications have happened in people with head and neck cancer who received Erbitux (cetuximab) in combination with radiation or platinum-based chemotherapy with fluorouracil. Tell your provider if you have a history of heart problems, as you’ll need to be monitored more closely while receiving Erbitux (cetuximab).
Severe lung or breathing problems
Though rare, some people receiving Erbitux (cetuximab) have experienced serious lung problems such as interstitial lung disease (ILD). Tell your provider right away if you have new or worsening shortness of breath, trouble breathing, chest pain or discomfort, or dry cough. You might have to pause or stop treatment with Erbitux (cetuximab) while your provider figures out the cause.
Severe skin problems
Erbitux (cetuximab) can cause skin problems, including acne-like rashes, dry or cracking skin, nail changes, and excessive hair growth anywhere on the body. In rare cases, it can cause severe skin reactions or infections, which can be life-threatening. Tell your provider immediately if you develop painful blisters, skin wounds, or peeling skin, as these are signs of a serious skin reaction that requires medical attention.
Electrolyte imbalances
Treatment with Erbitux (cetuximab) can lower your magnesium, calcium, and potassium levels in the body. This can occur anywhere from days to months after starting Erbitux (cetuximab). Your provider will closely monitor your electrolytes through routine lab work while you’re receiving this medication. Let your provider know if you experience muscle spasms, weakness, tremors, a racing heart, numbness or tingling, or dizziness, as these can be signs that your electrolyte levels are low.
Harm to unborn baby
Based on animal studies, Erbitux (cetuximab) can harm an unborn baby or raise the risk for miscarriage (pregnancy loss). Because of these risks, if you’re a woman who can get pregnant, you should use birth control while receiving Erbitux (cetuximab) and for 2 months after the last dose. Let your provider know right away if you become pregnant during this time.
Erbitux (cetuximab) dosage
Typical dosage for Erbitux (cetuximab)
Erbitux (cetuximab) is an injection into a vein (intravenous, IV) that’s given by a healthcare provider. The dose depends on your body surface area (BSA), which takes into account your body weight and height. Your healthcare provider will determine the appropriate dose for you each time you receive the medication.
The typical dose is 400 mg/m2 for the first injection, and then 250 mg/m2 given once a week. It can also be given as 500 mg/m2 for the first injection and then every other week thereafter.
Interactions between Erbitux (cetuximab) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Tofacitinib
