Necitumumab is prescribed to treat squamous non-small cell lung cancer in combination with cisplatin and gemcitabine as a first-line treatment in adult patients whose cancer has moved to other parts of the body.
Necitumumab is a human monoclonal antibody that works by blocking the actions of the epidermal growth factor receptor and thereby reduces the multiplication of cancer cells and stops or slows down the growth of cancer cells.
Necitumumab should not be used in patients with-
• Allergic to necitumumab
• History of non-squamous non-small cell lung cancer
• Pregnancy and breastfeeding
• Children below 18 years of age
• Risk of thromboembolic disorders (Formation of blood clots in the legs, lungs or brain)
• The recommended dose of necitumumab is 800 mg given on the first day and the 8th day of every three-week cycle before giving gemcitabine and cisplatin.
• The treatment with necitumumab can be continued in patients who never show the disease progression or when the treatment with the drug does not result in unacceptable toxicity.
• The dose of necitumumab can be reduced to 400 mg if infusion-related side effects or skin reactions occur. The treatment with necitumumab can be permanently discontinued if the side effects are life-threatening.
• Necitumumab is available in an injection form which should be given intravenously or directly into the vein very slowly for about 1 hour.
• Necitumumab should be diluted with 0.9% sodium chloride to make up the final volume of 250 ml, and the mixture should be gently inverted to facilitate adequate mixing.
• Avoid diluting with dextrose solution and other intravenous (IV) solutions and administer necitumumab infusion through a separate IV line.
• Flush the IV line with 0.9% sodium chloride solution after the contents of necitumumab solution are infused into the body completely.
• Inspect the necitumumab vial for the presence of discoloration or any particulate matter and discard the vial immediately if any such things are noticed.
• Patients can be given antiallergic medication such as diphenhydramine, fever medication (Paracetamol), and steroids such as dexamethasone before starting the necitumumab infusion to reduce the side effects caused by necitumumab.
• Patients with a strong history of heart disease or severe lung disease (Chronic obstructive pulmonary disease) should be monitored closely as necitumumab can cause cardiopulmonary arrest or sudden death.
• Checking the levels of magnesium, potassium, and calcium before each infusion of necitumumab treatment and for at least eight weeks after taking the last dose of necitumumab is necessary to detect and treat if any reports of low levels of magnesium, potassium, and calcium are found.
• Treatment with necitumumab can be stopped temporarily, and electrolytes can be given to the patient if such low levels of electrolyte abnormalities are reported.
• Patients can experience certain symptoms of heart attack, damage to the heart, lungs or brain due to the interruption of blood supply when treated with necitumumab along with gemcitabine and cisplatin. So, caution is required in treating such patients.
• Infusion-related reactions and skin reactions such as rashes, itching, pimples or dry skin have been reported in patients given necitumumab infusion usually within the first two weeks of treatment; if the reactions are severe the treatment can be permanently stopped.
• Gastrointestinal: Nausea, vomiting, mouth ulcers, pain and swelling of the digestive tract, difficulty in swallowing
• Respiratory: Coughing up blood, breathing difficulty, blood clots in lungs
• Skin: Rashes, itching, dry skin, pimples, cracks in the skin
• Eye: Irritation and itching of the eye, pain, blurred vision, increased tear secretion
• Lab abnormalities: Low levels of magnesium, potassium, calcium, and phosphate
• Others: Pulmonary embolism, cerebral stroke, heart attack, headache, weight loss
• Females of reproductive potential living with active male partners should use effective contraception during the treatment with necitumumab and must continue the contraception for at least three months after the last dose of necitumumab.
• Breastfeeding should be stopped during the necitumumab treatment and for three months after stopping to take necitumumab.
Patients who take prescription, Over-The-Counter drugs or herbal supplements should inform the doctor before necitumumab is given to avoid dangerous side effects.
• Store necitumumab vials at cold storage in a refrigerator between 2°C and 8°C.
• Protect the vials from light and do not freeze or shake the vial.
• Diluted necitumumab solutions can be used for up to 24 hours if it is stored in a refrigerator at 2-8°C and can be used for up to 4 hours if kept at room temperature i.e., below 25°C.
• Any unused solutions left after that should be discarded.
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