Cetumixab – Intravenous

Cetuximab is a very strong drug used to attack cancer cells by preventing them from being able to grow and multiply.

Overview

Cetuximab is a form of medication which belongs to a group of pharmaceuticals collectively known as monoclonal antibodies. It is sometimes referred to as a ‘targeted cancer therapy’ and is used to specifically treat bowel (colon and rectal) cancer. It works by only focussing on a particular type of protein or receptor which can be found on a cell’s surface. Some cancer cells have huge quantities of these receptors on their surfaces and it is these receptors which tell the cancer cells to reproduce and to increase in size. Cetuximab fights cancer by locking onto these growth receptors and stopping them from being able to divide, grow or reproduce. It may also have the added benefit of weakening the cells so that they become more responsive to other forms of treatment such as chemotherapy and radiotherapy.

Before prescribing a course of cetuximab, doctors will perform tests on the bowel cancer to ensure that it will be susceptible to this form of treatment. Cetuximab is only effective in inhibiting the growth of cancers which have a normal RAS gene, as it is not effective in patients where the cancer genes have begun to mutate. It is only used to treat advanced patients where the cancer has started to spread from the original affected area. It is often used in conjunction with chemotherapy or radiotherapy to increase the rate at which the cancer is treated.

Cetuximab is a strong treatment which is prescribed in patients who are potentially fighting for their lives. It is not a cure for cancer, but rather a drug which is able to maintain its current state without allowing it to make further progress throughout the body. This paves the way for different treatments to be more effective in their destruction of the cancerous cells. It is an aggressive drug which often takes its toll on the body and causes patients to suffer from severe side effects. Nausea and vomiting are the two most common side effects associated with this treatment, and whilst these symptoms may not put the life of the patient in immediate danger, they can be very serious and cause distress, discomfort and additional pain. Doctors will prescribe this course of treatment in spite of the side effects it causes if they believe that the potential benefits in the treatment of cancer will outweigh the temporary side effects associated with taking cetuximab.

Conditions treated:

  • Bowel Cancer
  • Head and neck cancer

Type of medicine?:

  • Monoclonal antibody

Side effects:

Cetuximab is an aggressive drug which is designed to attack cells within the human body. It is an effective treatment for advanced cancers because it is so aggressive, but this means that it can also take its toll on the rest of the body. It is very common for patients on a course of cetuximab to experience side effects, some of which can be very unpleasant and severe. The most common side effects are as follows:

  • Nausea
  • Vomiting
  • Constipation
  • Diarrhea
  • Headaches
  • Stomach cramps
  • Back Pain
  • fever/chills
  • Insomnia
  • Sudden weight loss
  • Fatigue
  • Dry skin
  • Sore or irritated eyes
  • Changes to nail colour and strength
  • Mouth ulcers

There are some things which can be done in order to manage the side effects or prevent them from occurring to such a severe extent. Doctors find that if patients do not eat before their treatment, this can help to prevent or lessen nausea and vomiting for some people. Changing the diet in general to include smaller meals can also help whilst having the treatment and during recovery from a treatment session. Doctors will prescribe this medication despite the severity of the side effects as it can be part of a patient’s only possible treatment plan in order to beat cancer. However, if there are sudden changes in the way in which the side effects present themselves, this could be a cause for concern and patients should tell their doctor straight away if anything changes. In some cases, the dose of cetuximab prescribed may be lowered in order to try and lessen the side effects experienced.

There are a few side effects which are more serious but less common. These possible side effects include:

  • Severe acne-like rash
  • Depression
  • Confusion and dizziness
  • Severe dehydration
  • Kidney damage
  • Urinary problems
  • Inhibited vision
  • Severe muscle spasms
  • Serious infection
  • Increased irregular heartbeat
  • Lung problems
  • Difficulty breathing

Patients who experience any of the above during or after cetuximab treatment should seek urgent medical attention to prevent the problems from escalating further.

Dosage

A solution of cetuximab is usually injected into a vein by a nurse or healthcare professional. This dose is normally administered once a week. For the first treatment, patients are usually given a large dose as an initial loading dose which is given over the course of two hours. From this point on, the doses will be smaller and usually given over the course of one hour once a week.

The dosage will vary depending on the age, body weight, general health and specific condition of each patient. Doctors will calculate the dose according to each of these factors and will potentially amend the dose if necessary as the weeks progress.

Patients receiving cetuximab are usually monitored whilst they are receiving the drug and for at least an hour afterward in order to check for signs of infusion reactions.

Interactions

When any two or more drugs are prescribed to be taken at the same time, there is always the possibility of interactions occurring between the different pharmaceuticals. In order to limit the possibility of this happening, patients should always make their doctor aware of any existing medication they might be taking, both prescription and non-prescription drugs, before beginning a new course of treatment. In the case of cetuximab, it is particularly important to inform the doctor in the following instances:

Blood clots

Cetuximab has the potential to change the way in which the blood behaves within the body. This can lead to the forming of blood clots which can be dangerous if they are in a position where they can restrict blood flow from one part of the body to another. When combined with other drugs which could also cause blot clots, the possibility of this happening is significantly increased. Therefore drugs such as thalidomide and others which can potentially cause blood clots should be avoided if possible whilst a patient is taking cetuximab.

Ocular conditions

Cetuximab is also known to cause potential damage to the eyes and potentially trigger or exacerbate ocular conditions. If patients taking cetuximab notice a deterioration in their eyesight whilst taking the drug, especially if they have a pre-existing ocular condition, they should inform their doctor as soon as possible and seek urgent medical advice.

Warnings

Cetuximab is an incredibly aggressive treatment as it has been designed to treat an incredibly aggressive disease. It is therefore likely to cause major side effects and is also likely to interfere with other areas of a patient’s life. It is a potentially life-saving treatment which is only prescribed in the most extreme cases, but it can make all of the difference despite its aggressive approach.

Contraception

It is not advised for patients to conceive a child whilst taking this medication. Both male and female fertility can be affected, and there has not been enough research conducted to rule out any harm which could be done to a baby who was conceived whilst one of their parents was receiving this treatment. Effective forms of contraception should be discussed with a doctor or nurse so as to find methods which will not interact with the drug.

Breastfeeding

Cetuximab may pass into breast milk if the breastfeeding mother is currently receiving this treatment. Due to the nature of the drug, it may also stay in the system for up to several months after treatment has finished. It is therefore not advised for mothers to breastfeed during cetuximab treatment and not for at least four months after having finished the course of treatment.

Dental treatment

You should let your dentist know if you have an appointment with them whilst taking cetuximab. It may have an impact on your dental health and this is information which could be vital to offering you the best care whilst undergoing treatment.

Allergic reactions

It is possible for patients to have an allergic reaction to cetuximab. Patients who are allergic to red meat and/or ticks are more likely to have a severe allergic reaction than other people. You should tell your doctor immediately if you are allergic to any of these things and have been prescribed a course of cetuximab as a treatment.

Storage

Cetuximab is a drug which is only administered by medical institutions. It would not be prescribed for a patient to take outside of the hospital or another medical facility. It will, therefore, be kept in controlled conditions and is unlikely to need storage outside of a hospital.

As with all medications, cetuximab should be stored in the manufacturer’s container, ensuring that the factory seal is not compromised. It should be kept out of direct sunlight and away from moisture or excess changes in temperature. Ideally, cetuximab should be refrigerated at a temperature of between 2°C and 8°C.

Summary

Cetuximab is a drug which is prescribed to patients who have been diagnosed with severe and advanced forms of bowel cancer, and occasionally to patients with forms of head and neck cancer. It is used as a treatment for patients whose cancer has already begun to spread from the original affected areas and has started to attack other parts of the body. Cetuximab is designed to attack the receptors in cancer cells which are responsible for the cells’ ability to grow and multiply. This therefore effectively stops the cancer from being able to spread further throughout the body, slowing down its progress and making way for other treatments to be able to diminish the cancer cells. Cetuximab is therefore often partnered with chemotherapy or radiotherapy as part of a larger treatment plan for patients.

It is a very strong drug and therefore produces a number of fairly serious side effects. Almost all patients who take cetuximab will experience side effects which are likely to be extremely unpleasant, even if they are not putting the patient at further risk of harm. However, in most cases, there is little choice about whether or not to proceed with treatment as it could be a life-saving course of medicine.