2 The technology
2.1 Cetuximab (Erbitux, Merck Pharmaceuticals) is a chimeric immunoglobulin G monoclonal antibody that competes for epidermal growth factor receptor (EGFR) binding sites on the external surface of the cell membrane. Binding of cetuximab to EGFR prevents activation of tyrosine kinase within cells, eventually resulting in apoptosis. Cetuximab, in combination with radiotherapy, is licensed for the treatment of patients with locally advanced squamous cell cancer of the head and neck. For further information, see the summary of product characteristics (SPC).
2.2 The most common side effects of cetuximab are mild or moderate infusion-related reactions such as fever, chills, nausea, vomiting, headache, dizziness or dyspnoea that occur soon after the first cetuximab infusion. Skin reactions develop in more than 80% of patients and mainly present as an acne-like rash or, less frequently, as pruritus, dry skin, desquamation, hypertrichosis or nail disorders (for example, paronychia). The majority of skin reactions develop within the first 3 weeks of therapy. For full details of side effects and contraindications, see the SPC.
2.3 The acquisition cost of cetuximab is £136.50 for a 5-mg/ml, 20-ml vial (excluding VAT; 'British national formulary', edition 55). The initial dose is 400 mg/m2 body surface area. Subsequent weekly doses are 250 mg/m2 each. A course of treatment can range from 2 to 8 weeks. Assuming a body surface area range of 1.6 m2 to 1.8 m2, the drug cost of a course of treatment comprising two to eight cycles is £4778 to £5870. Costs may vary in different settings because of negotiated procurement discounts.