Cycle length: Weekly OR every 2 weeks.* | |||
Drug | Dose and route | Administration | Given on days |
Cetuximab (loading dose)[1] | 400 mg/m2 IV | The appropriate dose should be withdrawn from the vials (supplied in a concentration of 2 mg/mL) and aseptically transferred into an empty sterile IV bag without further dilution. The initial dose should be infused over 120 minutes.¶Δ | Day 1 |
Cetuximab (subsequent doses) | 250 mg/m2 IV | If the day 1 loading dose is tolerated, subsequent doses may be administered over 60 minutes. | Weekly, beginning day 8 |
OR | |||
Cetuximab (loading dose and subsequent doses)*[2] | 500 mg/m2 IV | The appropriate dose should be withdrawn from the vials (supplied in a concentration of 2 mg/mL) and aseptically transferred into an empty sterile IV bag without further dilution.¶Δ When administered every 2 weeks, all doses should be infused over 120 minutes. | Every 2 weeks |
Pretreatment considerations: | |||
Emesis risk |
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Prophylaxis for infusion reactions |
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Monitoring parameters: | |||
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Suggested dose modifications for toxicity: | |||
Dematologic toxicity |
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If there is a change in body weight of at least 10%, doses should be recalculated. |
FDA: US Food and Drug Administration; IgE: immunoglobulin E; IV: intravenous.
* Results from a nonrandomized phase II trial[3] and a multicenter retrospective analysis[4] suggest that cetuximab at a dose of 500 mg/m2 initially followed by 500 mg/m2 every two weeks results in similar plasma concentrations and single-agent activity as does weekly dosing. This alternative dosing regimen is approved by the FDA.[2]
¶ Cetuximab should be administered with an infusion or syringe pump, using a low protein-binding 0.22 micron in line filter. Do not shake or dilute. Flush line with normal saline.
Δ A slower infusion rate should be considered in areas with a high incidence of infusion reactions (such as the southeast United States). Refer to UpToDate topics on infusion reactions to the therapeutic monoclonal antibodies used in cancer therapy.
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