Adverse Events of Cetuximab Plus Radiotherapy and Countermeasures

Abstract

Cetuximab plus radiotherapy has been shown to be a useful treatment for locoregionally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). At our institute, we have begun to use cetuximab plus radiotherapy for LA-SCCHN in August 2013. In this paper, we report the adverse events of cetuximab plus radiotherapy and the countermeasures adopted by us at our institute. We applied this treatment regimen for 15 patients. The site of the primary lesion were as follows; oropharynx (3 cases), hypopharynx (8 cases), larynx (3 cases), and unknown (1 case). The distribution of the disease stage was as follows; Stage II (5 cases), Stage IVA (8 cases), and Stage IVB (1 case). The treatment was administered in accordance with the protocol in the Bonner trial. The treatment completion rate in the initial period of observation was 66.7%, while the rate improved in the latter part of the observation period. Presumably, the rate improved in the latter part of the treatment period because we adopted measures for management of the adverse effects of radiation dermatitis and oral mucositis. No serious infusion reactions were observed. We observed grade 3 radiation dermatitis in 6 cases, oral mucositis in 5 cases and grade 4 interstitial pneumonia in 1 case. The patients with interstitial pneumonia recovered with steroid pulse therapy, however, the radiation therapy had to be discontinued. Cetuximab plus radiotherapy is a very useful treatment method for squamous cell carcinoma of the head and neck, however, it is associated with a high risk of serious adverse events. Thus, patients should be carefully selected for cetuximab plus radiotherapy.