Anti-EGFR Monoclonal Antibody — Head and Neck Cancer
Pregnancy: Contraindicated — teratogenic; effective contraception required during and for 2 months after treatment
Cetuximab
Brand names: Erbitux
Adult dose
Dose: Loading dose: 400 mg/m² IV over 2 hours. Maintenance: 250 mg/m² IV over 1 hour weekly
Route: IV infusion
Frequency: Weekly (maintenance); combined with platinum-based chemotherapy or radiotherapy
Max: 400 mg/m² loading; 250 mg/m² weekly maintenance
Anti-EGFR mAb for locally advanced head and neck squamous cell carcinoma (HNSCC) — combined with radiotherapy (Bonner regimen) or first-line with platinum/5-FU (EXTREME regimen) for recurrent/metastatic HNSCC. EGFR expression testing not required (EGFR universally overexpressed in HNSCC).
Paediatric dose
Dose: Seek specialist opinion mg/m²/kg
Route: IV
Frequency: Weekly
Max: Not established in children
Not licensed in children — specialist paediatric oncology use only
Dose adjustments
Renal
No dose adjustment required
Hepatic
No dose adjustment in mild-moderate impairment; use with caution in severe impairment
Paediatric weight-based calculator
Not licensed in children — specialist paediatric oncology use only
Clinical pearls
- Bonner trial: cetuximab + radiotherapy significantly improved locoregional control and OS vs radiotherapy alone in locally advanced HNSCC (median OS 49 vs 29 months)
- Acneiform rash severity correlates with treatment response — paradoxically, patients who develop grade 2+ rash have significantly better outcomes
- Hypomagnesaemia: cetuximab inhibits renal magnesium reabsorption — check and replace magnesium weekly during treatment; can be severe
- Infusion-related reactions: premedicate with antihistamine and corticosteroid; fatal anaphylaxis reported — resuscitation equipment must be available
- HPV+ HNSCC (oropharyngeal): immunotherapy (pembrolizumab) increasingly preferred over cetuximab-based regimens in recurrent/metastatic disease (KEYNOTE-048)
- EXTREME regimen: cetuximab + cisplatin + 5-FU is standard first-line for recurrent/metastatic HNSCC ineligible for curative therapy
Contraindications
- Hypersensitivity to cetuximab
- Prior severe infusion reaction to cetuximab
- Combination with oxaliplatin in colorectal cancer (KRAS wild-type required — not relevant for HNSCC)
Side effects
- Acneiform rash (80–90% — correlates with efficacy)
- Infusion-related reactions (including severe anaphylaxis — premedicate)
- Hypomagnesaemia
- Fatigue
- Mucositis
- Paronychia (nail inflammation)
Interactions
- Radiotherapy — enhanced skin toxicity (radiation recall/dermatitis)
- Fluorouracil — standard combination in EXTREME regimen
Monitoring
- Skin toxicity (weekly rash assessment)
- Serum magnesium (weekly)
- FBC
- Renal function
- Infusion reactions
Reference: BNFc; BNF 90; Bonner Trial (NEJM 2006); EXTREME Trial (Vermorken et al. NEJM 2008); NICE TA145; SPC Erbitux. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators