Cetuximab

Targeted agents - monocolonal antibody - anti-EGFR (Cetuximab)

Colorectal cancer

• useful in wild-type KRAS/BRAF
  • not effective in adjuvant setting.
  • Useful for metastases.
    • Resectable liver mets
      • Should not be used in the perioperative setting for resectable patients given trials demonstrating OS detriment.
    • Palliative mets
      • Efficacy of adding anti-EGFR medications like cetuximab or panitumumab to first-line chemotherapy regimens in the palliation of patients with inoperable wild-type KRAS metastatic CRC. SCC
• adjuvant treatment

FDA-Approved Uses

1. Colorectal cancer, metastatic, KRAS wild-type (without mutation) - Cetuximab improves both overall survival and progression-free survival and preserves quality-of-life measures for patients with colorectal cancer where other treatments have failed. There is a limitation of use. Patients with colorectal tumor-bearing mutated K-ras did not benefit from cetuximab, whereas patients with tumor-bearing wild-type K-ras benefited from cetuximab. If KRAS mutation in either codon 12 or 13 is detected, then patients with metastatic colorectal carcinoma should not receive anti-EGFR antibody therapy.

2. Head and neck cancer (squamous cell) - Treatment for locoregionally advanced head and neck cancer with concomitant high-dose radiotherapy plus cetuximab demonstrates improvement of locoregional control and lowers mortality without increasing the common toxic effects associated with radiotherapy to the head and neck. Cetuximab plus platinum-fluorouracil chemotherapy improved overall survival when given as first-line treatment for patients with recurrent or metastatic squamous-cell carcinoma of the head and neck