cetuximab at a glance
Medicine class
EGFR-targeting monoclonal antibody
Main uses
Selected metastatic colorectal cancers and squamous-cell cancers of the head and neck
Administration
Intravenous infusion in a specialist cancer unit, with premedication and observation for reactions
Important testing
Colorectal tumours require appropriate RAS testing; BRAF V600E confirmation is required when combined with encorafenib
What is cetuximab used for?
Licensed uses represented by the selected product include:
EGFR-expressing, RAS wild-type metastatic colorectal cancer with specified chemotherapy combinations or, in defined circumstances, alone.
Previously treated metastatic colorectal cancer with confirmed BRAF V600E mutation, combined with encorafenib.
Locally advanced squamous-cell cancer of the head and neck, combined with radiotherapy.
Recurrent or metastatic squamous-cell cancer of the head and neck, combined with platinum-based chemotherapy.
How does cetuximab work?
Cetuximab binds to EGFR on susceptible cancer cells and blocks growth-promoting signals. It also promotes receptor internalisation and can direct immune effector cells against EGFR-expressing tumour cells. Activating RAS mutations can bypass this blockade, so tumour testing is needed in colorectal cancer.
cetuximab preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 5 mg/mL
How to take cetuximab
Cetuximab is prepared and infused into a vein by trained healthcare professionals. Premedication is used to reduce infusion reactions, and patients are monitored during administration and afterwards because reactions can be delayed.
It is not taken by mouth, so food does not affect administration.
Tell staff immediately about fever, chills, dizziness, rash, breathing difficulty, faintness or chest pain during the infusion.
Tell the cancer team about all prescribed, non-prescription and complementary products.
cetuximab side effects
Common or expected effects
- Acne-like rash, itching, dry or scaling skin and nail inflammation
- Mild or moderate infusion reactions, including fever, chills, dizziness or breathing difficulty
- Sore or inflamed mouth and other mucosal surfaces
- Low magnesium levels
- Raised liver enzymes
- Diarrhoea, nausea or vomiting
- Headache, tiredness or conjunctivitis
- Reduced appetite, dehydration or low calcium
Get urgent medical advice
- Severe infusion reaction, with rapid breathing difficulty, hives, fainting, chest pain or shock
- Blistering or peeling skin, or rapidly worsening skin lesions
- Fever or marked tiredness with infected-looking skin lesions
- New or worsening breathlessness, particularly with cough or fever
- Eye pain, marked redness, light sensitivity or worsening blurred vision
- Possible blood clot symptoms, such as one-sided leg swelling, sudden chest pain or unexplained breathlessness
cetuximab in pregnancy
Human pregnancy information is limited, and IgG1 antibodies can cross the placenta. Cetuximab should be considered during pregnancy only when the potential maternal benefit justifies the possible fetal risk. Discuss pregnancy or unreliable contraception with the oncology team before treatment.
cetuximab while breastfeeding
Breastfeeding is not recommended during treatment or for two months after treatment ends because it is unknown whether cetuximab enters breast milk. Discuss feeding plans with the oncology and maternity teams.
cetuximab interactions
Combination treatment can increase particular toxicities. Information for every accompanying treatment must also be reviewed.
Platinum-based chemotherapy
May increase severe neutropenia and infectious complications; severe hypocalcaemia may also be more frequent.
Fluoropyrimidines
May increase cardiac ischaemia, heart failure and hand-foot syndrome.
Capecitabine plus oxaliplatin
May increase severe diarrhoea.
Irinotecan
A formal study found no meaningful change in the pharmacokinetics of either treatment.
Common questions about cetuximab
Answers are fully visible for fast scanning and source review.
Is cetuximab chemotherapy or immunotherapy?
It is a targeted monoclonal antibody rather than conventional cytotoxic chemotherapy. It may be used alone or with chemotherapy or radiotherapy, depending on the cancer.
Why is RAS testing needed?
RAS mutations can keep growth signalling active despite EGFR blockade. Cetuximab should not be used for colorectal cancer with mutated or unknown RAS status.
When is BRAF testing needed?
A validated test must confirm BRAF V600E mutation when cetuximab is being considered with encorafenib for previously treated metastatic colorectal cancer.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.