Cetuximab

How it works

It binds the EGFR, blocking ligand-induced receptor activation and downstream signalling that drives tumour growth, and is given as an intravenous infusion.

Prescribing in practice

• Severe infusion-related and hypersensitivity reactions, including anaphylaxis, can occur (often with the first infusion), so premedication, slow administration and resuscitation facilities are required and patients must be monitored during and after infusion.
• An acneiform skin rash is very common and its severity correlates with response, while hypomagnesaemia is frequent and requires electrolyte monitoring and replacement.
• It is administered under specialist oncology supervision as part of defined regimens, not as monotherapy outside its licensed combinations.

Monitoring

Monitor for infusion reactions, serum magnesium and other electrolytes, and skin toxicity throughout treatment.

Counselling the patient

• Report any rash, fever, breathlessness or faintness during or after the infusion straight away.
• A spot-like skin rash is common; tell the team so it can be managed and protect skin from sun.
• Regular blood tests are needed to check magnesium and other levels.

Evidence & guidelines

Cetuximab with radiotherapy improves outcomes in locally advanced head and neck squamous cell carcinoma and is established in oncology guidelines for selected patients.