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This information is about a treatment for advanced bowel cancer using a combination of a chemotherapy drug and a monoclonal antibody. It describes the drugs, how they are given and some of the possible side effects.
If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.
The treatment involves the chemotherapy drug irinotecan which is also known as Campto®, and the monoclonal antibody cetuximab, which is also known as Erbitux®.
Cetuximab is a type of drug known as a monoclonal antibody. These antibodies are used to try to destroy some types of cancer cells while causing little harm to normal cells.
Monoclonal antibodies are designed to recognise certain proteins (receptors) known as epidermal growth factor receptors or EGFRs that are found on the surface of particular cancer cells.
When growth factors such as epidermal growth factor bind to the receptor, the cancer cell is stimulated to grow and divide.
Cetuximab attaches itself to the EGFRs and prevents the receptors from being activated. This stops the cells from growing and dividing. Cetuximab may also make the cancer cells more sensitive to chemotherapy.
This treatment is usually given to you as a day patient. Before you start treatment you will need a blood test (on the same day or a few days before) and will be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. All this may take a couple of hours.
The nurse will put a thin tube (cannula) into a vein in your arm or hand. You may find this uncomfortable or a little painful but it should not take long. Some people have their chemotherapy given through a thin plastic tube that is inserted under the skin into a vein near the collarbone (central line) or through a vein in their arm (PICC line). Your doctor or nurse will explain more about this to you.
You will be given an anti-sickness (anti-emetic) drug and also some other medicines to help lessen side effects during treatment. These are usually given by injection through the cannula or through your central or PICC line, but some anti-sickness medicines may be given as tablets.
The treatment drugs are then given separately. Both cetuximab and irinotecan are given as a drip (infusion).
If you are having your treatment as a day patient you can go home after the treatment is finished. The cannula will be removed and you will be given a supply of anti-sickness tablets to take with you. It is important to take these as directed even if you are not feeling sick, as most anti-sickness drugs are much better at preventing sickness than stopping it once it starts.
The first cetuximab dose is given slowly, usually over two hours. Subsequent weekly treatments are given at a lower dose, over about an hour. After the cetuximab there will be a gap of at least one hour before having the irinotecan. You may have a saline (salt water) infusion during this time. The irinotecan is given as a drip over 30 to 90 minutes. You will have the irinotecan either:
The dose will vary depending on how often you have it.
Each person’s reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described here will not affect everyone who is given irinotecan and cetuximab chemotherapy. We have outlined the most common ones and those that are less common, so that you can be aware of them if they occur. However, we have not included those which are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug but which are not listed here, please let your doctor or nurse know.
Allergic reaction Cetuximab can occasionally cause an allergic reaction. Signs of this include skin rashes and itching; a feeling of swelling in the tongue or throat; irritation of the nasal passages; wheezing; a cough; and breathlessness. You will be monitored closely during your treatment, but tell your nurse or doctor if you have any of these symptoms. To reduce the chance of developing an allergic reaction, medicines (usually antihistamines) can be given before the infusion. The drip can also be slowed down or stopped until the reaction is over.
Breathlessness Some people having cetuximab may become breathless. This is more likely if you already have lung problems. Let your doctor know if you notice any increase in breathlessness.
Skin changes Mild skin rashes are very common with cetuximab. They begin during the first two weeks of treatment and usually go away completely when the treatment stops. Some people have more severe skin changes, which can include reddening of the skin and red pimples and spots on the face. The skin of the face may also become flaky and scaly. Some people have dry skin, like eczema, on their fingertips, elbows and extremities, which is sore and itchy. If you have any of these skin changes let your doctor know straight away. If you have very severe skin problems the length of time between the treatments may be extended or the dose may be lowered. Treatment can be prescribed by your doctor to reduce the rash.
To help reduce dry skin eczema, try to avoid things that make your skin dry, such as too much central heating and soap. Your doctor can prescribe creams to moisturise your skin.
Irinotecan can also cause a rash which may be itchy, although this is less common.
Diarrhoea This may occur with the cetuximab or irinotecan and can usually be controlled with medicine – but let your doctor know if it is severe or continues.
Delayed diarrhoea This is when diarrhoea occurs more than 24 hours after an infusion. It can usually be easily controlled but is sometimes severe. If you get diarrhoea and abdominal cramps; start taking the anti-diarrhoea medicine (usually loperamide) that you have been given. These medicines should be taken exactly as you have been instructed by the hospital treating you, (this may be different from any printed leaflets provided by the manufacturer).
Normally your doctor will tell you to take two tablets or capsules after the first loose stool and then one every two hours until you have not had a loose bowel movement for 12 hours. If loperamide does not work quickly (particularly if you still have diarrhoea after 48 hours or diarrhoea at night) it is important that you contact the hospital straight away. You may become dehydrated if you have a lot of diarrhoea. In some situations you may be asked to take special fluids to re-hydrate you and replace any salts that you have lost. Antibiotics are also sometimes given if the diarrhoea is persistent.
Lowered resistance to infection Irinotecan can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily, and will usually have returned to normal levels before your next cycle of chemotherapy is due.
Contact the hospital straightaway if:
You will have a blood test before having more chemotherapy, to make sure that your cells have recovered. Occasionally, it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.
Bruising or bleeding Irinotecan can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.
Anaemia (low number of red blood cells) While having treatment with irinotecan you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if this happens to you.
Increased sweating, production of saliva, stomach cramps and diarrhoea This is a particular group of side effects that are known as acute cholinergic syndrome. They happen because irinotecan can cause the cells in the body to release too much of a chemical called acetylcholine. The side effects tend to happen within the first 24 hours after an infusion of irinotecan.
These symptoms can usually be prevented or controlled by a drug called atropine. The atropine is given as an injection under the skin (subcutaneously), which can be repeated if necessary.
Nausea (feeling sick) and being sick (vomiting) There are now very effective anti-sickness medicines to prevent or greatly reduce nausea and vomiting. If you do feel sick, it may begin a few hours after the treatment is given and can last for up to a day. It is best to take the anti-sickness medicines exactly as they are prescribed for you. If the sickness is not controlled or continues tell your doctor, who can prescribe other anti-sickness drugs which may be more effective.
Loss of appetite This can be mild and may last a few days or so. The dietician at the hospital can give you advice about boosting your appetite, coping with eating difficulties and maintaining your weight.
Hair loss This usually starts 3–4 weeks after the first course of treatment and is due to the irinotecan. You will usually lose all your hair. You may also have thinning and loss of eyelashes, eyebrows and other body hair. This is temporary and the hair will grow again once the treatment ends.
Tiredness and a general feeling of weakness Many people feel extremely tired during chemotherapy. This is a very common side effect and it is important to try to get as much rest as you need.
Sore mouth and taste change Your mouth may become sore, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help to reduce the risk of this happening. Tell your doctor if you have any of these problems, as special mouthwashes and medicines to prevent or clear any mouth infection can be prescribed.
You may notice that your food tastes different. Normal taste will come back after the treatment finishes.
Muscle cramps Tell your doctor if you have muscle cramps, so that suitable painkillers can be prescribed.
Temporary effect on liver function The treatment may cause changes in the way that your liver works, though your liver will return to normal when the treatment is finished. You are very unlikely to notice any problems but you will need to have a blood test to check your liver function before each treatment.
Fever and chills If you develop a fever or chills let your doctor know.
Sore eyes You may notice that your eyes become sore, red and itchy. This is known as conjunctivitis. Your doctor can prescribe eye drops to help.
Some other medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medicines you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.
Fertility Your ability to become pregnant or father a child may be affected by taking these drugs. It is important to discuss fertility with your doctor before starting treatment.
Contraception It is not advisable to become pregnant or father a child while taking irinotecan, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.
This section is based upon our irinotecan and cetuximab factsheet which has been compiled using information from a number of reliable sources, including:
For further references, please see the general bibliography.
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