Cetuximab

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thephotoguy
Posts: 3
Joined: Mon Mar 18, 2024 10:22 pm

Cetuximab

Postby thephotoguy » Mon Mar 25, 2024 12:55 pm

A family member has been dealing with rectal cancer since Spring 2022. Recently they had a recurrence of the liver tumor but on the other side with two small spots on one of the lungs. She has previously been on 5Fu, Oxaliplatin, and leucovorin with "good" results. She has had a rectal resection, illestomy, and a resection of her liver previously.

She will be start up again on 5Fu, Oxaliplatin, and leucovorin but are adding Cetuximab to the treatment this time. Any tips or ideas with dealing with Cetuximab as we don't have any experience with that.

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Green Tea
Posts: 461
Joined: Mon Oct 24, 2016 10:48 am

Re: Cetuximab

Postby Green Tea » Tue Mar 26, 2024 2:33 am

thephotoguy wrote:A family member has been dealing with rectal cancer since Spring 2022. Recently they had a recurrence of the liver tumor but on the other side with two small spots on one of the lungs. She has previously been on 5Fu, Oxaliplatin, and leucovorin with "good" results. She has had a rectal resection, illestomy, and a resection of her liver previously.

She will be start up again on 5Fu, Oxaliplatin, and leucovorin but are adding Cetuximab to the treatment this time. Any tips or ideas with dealing with Cetuximab as we don't have any experience with that.

Cetuximab(Erbitux) is an anti-EGFR therapy that requires RAS mutational testing. Has this testing been done? If so, what were the results?

Reference:
    "...Patients with CRC considered for anti-EGFR therapy must receive RAS mutational testing. Mutational analysis should include KRAS and NRAS codons 12 and 13 of exon 2, 59 and 61 of exon 3, and 117 and 146 of exon 4 (expanded or extended RAS); Type: recommendation; Strength of evidence: convincing/adequate, benefits outweigh harms; Quality of evidence: high/intermediate).
    https://ascopubs.org/doi/full/10.1200/JOP.2017.022152

    "...FDA-approved drug label for cetuximab states that for mCRC, cetuximab is indicated for K- and N-RAS wild-type (no mutation), EGFR-expressing tumors. The label states that an FDA-approved test must be used to confirm the absence of a RAS mutation (in either KRAS or NRAS) prior to starting cetuximab (Table 1) (1). While the FDA label also states that EGFR expression should also be confirmed by an approved test prior to starting therapy for mCRC, this is largely not implemented in practice, nor is it recommended by professional oncology society guidelines."
    Source:
    https://www.ncbi.nlm.nih.gov/books/NBK564547/
Last edited by Green Tea on Wed Mar 27, 2024 3:39 am, edited 5 times in total.

User avatar
Green Tea
Posts: 461
Joined: Mon Oct 24, 2016 10:48 am

Re: Cetuximab

Postby Green Tea » Tue Mar 26, 2024 3:44 am

thephotoguy wrote:A family member has been dealing with rectal cancer since Spring 2022. Recently they had a recurrence of the liver tumor but on the other side with two small spots on one of the lungs. She has previously been on 5Fu, Oxaliplatin, and leucovorin with "good" results. She has had a rectal resection, illestomy, and a resection of her liver previously.

She will be start up again on 5Fu, Oxaliplatin, and leucovorin but are adding Cetuximab to the treatment this time. Any tips or ideas with dealing with Cetuximab as we don't have any experience with that.

Tips for Cetuximab-induced skin rash:
https://fightcolorectalcancer.org/resources/skin-toxicity-mini-magazine

stu
Posts: 1614
Joined: Sat Aug 17, 2013 5:46 pm

Re: Cetuximab

Postby stu » Wed Mar 27, 2024 1:23 pm

Hi ,
My mum just completed ten months on this alone .
It was interesting to see the difference between chemo and Cetuximab.
Unlike the cumulative effects of chemo Cetuximab seemed to take its turn with each individual side effect and after staying for a cycle or possible two slipped back into the background . I read an article online but could never find it again which went through the order the side effects appeared in and it was pretty accurate.
The most obvious was skin alterations.
She stayed on continuous antibiotics , used a special body wash , not allowed to use deodorant etc and had a special steroid cream to keep in the fridge. She had to get ahead of the rash .
It flared quite quickly . Looked similar to teenage acne . But also a red look to the skin too .
What was most apparent was a leathery look to her skin . She had to be vigilant with keeping her moisturiser up . The hospital provided this but she could also use Altruist cream or Avenno .
After the first few round it settled back down and only one or two wee blotches .
Then her nail beds took a hammering . White cotton gloves were the solution and quite deep cuts . Mouth ulcers popped up later on in the process but a good mouth wash from the GP sorted that out quickly .
Big long eyelashes and brittle straw like hair not helped by using baby shampoo.
However on their own much more doable than chemo but could be a bit more to handle in combination with chemo agents .
However despite being on it alone my mum got tremendous shrinkage .
Even the oncologist was surprised .
Biggest issue , it stripped her magnesium. We tackled that by making our own breakfast cereal . Filled with every magnesium seed known to mankind with prunes and dried apricots.
All the very best ,
Stu
supporter to my mum who lives a great life despite a difficult diagnosis
stage4 2009 significant spread to liver
2010 colon /liver resection
chemo following recurrence
73% of liver removed
enjoying life treatment free
2016 lung resection
Oct 2017 nice clear scan . Two lung nodules disappeared
Oct 2018. Another clear scan .

thephotoguy
Posts: 3
Joined: Mon Mar 18, 2024 10:22 pm

Re: Cetuximab

Postby thephotoguy » Thu Apr 04, 2024 10:19 pm

Hello,

I appreciate the responses.

She is MS-Stable, KRAS Amplification, & NRAS Wildtype.

So far she has been doing okay since the treatment. The rash started to show up 5 days after the first treatment. She has been using Aquaphor but her doctor prescribed her an antibiotic as it was starting to hurt and was itchy.

stu
Posts: 1614
Joined: Sat Aug 17, 2013 5:46 pm

Re: Cetuximab

Postby stu » Fri Apr 05, 2024 5:28 pm

That’s good she is now on antibiotics .

It settles quite quickly .

However we have just found out how sun sensitive Cetuximab is . My mum has been off treatment for four months . She sat in the sunshine for half an hour last weekend and is now glowing . Something to be aware of .
Take care ,
Stu
supporter to my mum who lives a great life despite a difficult diagnosis
stage4 2009 significant spread to liver
2010 colon /liver resection
chemo following recurrence
73% of liver removed
enjoying life treatment free
2016 lung resection
Oct 2017 nice clear scan . Two lung nodules disappeared
Oct 2018. Another clear scan .


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