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IrMdG and cetuximab 527

IrMdG and cetuximab 527

This leaflet provides information on a course of cetuximab with irinotecan, 5 fluorouracil (5-FU) and folinic acid.  It will explain what this is and when and how it will be given.  It will also tell you about common side effects that you may experience.  Contact telephone numbers and details of how to obtain further information on this chemotherapy are given at the end of the leaflet.

This leaflet should be read alongside the ‘General information for patients receiving chemotherapy’ leaflet.  If you haven’t received this leaflet then please ask your nurse for a copy.

What is cetuximab with irinotecan, 5-FU and folinic acid chemotherapy?

This is a treatment which consists of a combination of drugs which work in different ways to treat your cancer.

  1. Cetuximab This is an artificially made antibody which attaches itself to cancer cells and stops them from growing.  It also helps your own immune system kill the cancer cells.  It is not chemotherapy.  
  2. Chemotherapy treatment

This part of your treatment consists of three drugs.  There are two chemotherapy drugs called irinotecan and 5-FU.  The other drug is called folinic acid.  This is not a chemotherapy drug but it helps the 5-FU work better.  Together these drugs are called irinotecan and modified deGramont or IrMdG for short. 

We will also give you medicine called atropine.  This is given as an injection.  It prevents some of the side effects which can occur.  

Why am I having cetuximab with IrMdG chemotherapy?

Your doctor has prescribed the treatment because it has been found to be effective in treating your type of cancer.

How often will I receive my chemotherapy? 

For the treatment to be most effective it is given at specific time intervals.  These are known as cycles.  It is usual to have a cycle every 2 weeks. Your doctor will discuss with you the exact number of cycles you will receive.

How will my chemotherapy be given?

To receive your chemotherapy you will need to have a fine tube put into a large vein in your upper arm.  This tube is called a PICC line.  Your PICC line is usually put in about a week before you start your chemotherapy.  It will stay in for the whole course of your treatment.  Your doctor will explain this to you in more detail.  We also have a leaflet that tells you more about PICC lines.

We will give you anti sickness medicine and the atropine injection first.  The cetuximab, irinotecan, 5FU and folinic acid chemotherapy is then given through a drip connected to your PICC line.  

The 5-FU will be given to you in two parts:

  • First it is given as an injection into your PICC line.  This takes a few minutes.
  • The second part of your 5-FU is put into a small portable pump.
  • The pump is attached to your PICC line 
  • The pump fits into a bag (bumbag) which you wear around your waist on a belt
  • The pump is set to empty over 46 hours
  • You then need to return to have the pump disconnected. 

How do I look after the portable pump?

We will tell you how your pump works and how to look after it.  We will also give you written information.

How often will I need to come to the hospital?

To receive this chemotherapy you will need to visit the hospital 3 times in every 2 week cycle.

1st visit - Outpatient clinic appointment  

You will have blood samples taken and we will check how you are feeling and discuss any problems you may have.  This is so we can check how the chemotherapy is affecting you.  If your blood results are satisfactory, your chemotherapy will be prescribed.  This appointment is usually a few days before your chemotherapy appointment.

2nd visit - Chemotherapy appointment

Cetuximab and chemotherapy appointment - You should be prepared to spend most of the day at the hospital for your first treatment.  Cetuximab is given slowly and we will observe you after the infusion to check your reaction.  For the rest of your treatments this appointment will be shorter.  You will spend about 6 hours in one of the day case treatment areas.  You will go home with your portable pump containing 5-FU.

3rd visit - Pump disconnection

This appointment is 2 days after your chemotherapy appointment.  You will return to one of the day case treatment areas to have your portable pump disconnected.  This should take about half an hour.

Can I bring relatives and friends with me? 

You are welcome to bring someone to stay with you during your treatment. Space is limited so there is not usually room for more than one person.  Treatment areas are not suitable for young children. 

What are the possible side effects?

There are a number of possible side effects which can occur with this chemotherapy.  The doctors, nurses and pharmacists can give you advice or answer any questions you may have.

Hair loss

You may lose your hair with this chemotherapy.  This is temporary and your hair will grow back when you finish your chemotherapy.  We can arrange a wig if you would like one, please ask your nurse for more information.  

We have a leaflet on coping with hair loss.  Please ask your nurse if you would like a copy. A method known as ‘scalp cooling’ or ‘cold capping’ can sometimes be used to prevent 

hair loss.  


Nausea and vomiting are uncommon these days as we will give you anti-sickness medicines which are usually extremely effective.  If you are sick more than once in 24 hours despite taking regular anti-sickness medicine when you are at home after your treatment, contact Velindre Cancer Centre for advice.  The telephone number is at the end of the leaflet.


You are at an increased risk of picking up infections because your white blood cells which help fight infections can be reduced by this treatment.  

If you develop an infection whilst your white blood cells are low, you are at risk of sepsis, this can be life threatening. 

Contact Velindre Cancer Centre immediately if you develop any signs of infection, for example flu like symptoms or a temperature above 37.5°centigrade or below 35.5°centigrade  The telephone number is at the end of the leaflet.


Diarrhoea is a recognised side effect of both cetuximab with irinotecan, 5FU and folinic acid chemotherapyand 5-FU.  This can either occur within 24 hours following treatment or from about five days after starting treatment.

Diarrhoea within 24 hours of treatment

Diarrhoea which occurs at the time of treatment or up to 24 hours after can come with other symptoms.  For example sweating, stomach pains, watering eyes, blurred vision or dizziness.  The atropine injection we give you before your treatment usually stops these symptoms. 

We do not recommend that you take anti-diarrhoeal tablets with this type of diarrhoea.  If you develop diarrhoea or any of the symptoms described within the first 24 hours after treatment please contact Velindre Cancer Centre immediately for advice.  The telephone number is at the end of the leaflet

Diarrhoea starting more than 24 hours after treatment

We will have given you medication to help stop diarrhoea. These are called loperamide.  You should take these as follows:

  • Take two loperamide tablets the first time you have the diarrhoea, then one tablet every 2 hours for at least 12 hours. You must continue to take the loperamide tablets until you have gone 12 hours without diarrhoea.  However, do not take them for more than 48 hours.
  • If the diarrhoea lasts more than 24 hours you should take the antibiotic tablets you have been given.  These are called ciprofloxacin.  Take these as directed on the box.  You should also contact Velindre Cancer Centre immediately for advice.  The telephone number is at the end of the leaflet.

It is important that you drink plenty of water and salty type liquids if you have diarrhoea.  These include soda water, carbonated water and soups.

Tiredness and fatigue

Chemotherapy can make you feel more tired than usual.  It is important to listen to your body and rest if you need to, but carry out your normal activities if you feel able.  Some people find it beneficial to take gentle exercise as well as rest.

Sore mouth

Your mouth may become sore or you may notice small ulcers.  Please follow the advice on caring for your mouth in the general chemotherapy leaflet.  Your doctor may prescribe mouthwashes or medication to prevent or clear any infection.

Skin reactions

Most people (more than 80%) experience a skin reaction with cetuximab.  This is usually an acne type rash which may be dry and itchy and cause mild discomfort.  For a small number of people this reaction may be more severe.  A severe rash would affect a large part of your body, may be painful and may become infected. 

To reduce the possibility of severe skin reaction we suggest that you:

  • use non-perfumed moisturising creams on your face and upper body from the start of your treatment.  Apply the cream on your body along the same direction as the hair growth.
  • Do not wet shave, use an electric razor. 
  • avoid exposure to the sun, wear a hat and use a high factor sunscreen.
  • don’t use hot water on your skin.
  • don’t use soap if your skin is dry - use a soap alternative such as aqueous cream, or a bath emollient such as oilatum.
  • Use a gentle shampoo, such as simple shampoo.  Do not use baby shampoo.
  • try not to rub your skin vigorously - pat gently dry 
  • try to wear gloves when washing dishes.
  • wear comfortable clothes and shoes that do not rub

Your hospital doctor will prescribe antibiotic tablets to help reduce the severity of your skin rash.    

If the spots become red and angry, your doctor may give you steroid cream and antibiotic cream to apply to the area.  If the spots start to look infected, contact Velindre Cancer Centre.

This skin reaction is temporary and will resolve completely after you have finished treatment.  If you develop a severe skin reaction which is causing you pain or stopping you carrying out your normal activities, please contact Velindre Cancer Centre for advice.  The telephone number is at the end of the leaflet.

Soreness to your hands and feet

You may experience mild pain, redness and swelling of your hands or feet.  If this occurs we recommend using a non perfumed cream or lotion regularly.  Please contact Velindre Cancer Centre if your hands or feet become painful.

Blood clots

A diagnosis of cancer can increase your risk of developing a blood clot (thrombosis), and having cancer treatment may increase this risk further.  It is important to tell your doctor immediately if you have symptoms such as pain, redness and swelling in your leg, or breathlessness and chest pain.  

Blood clots can be very serious.  However, most clots can usually be successfully treated with drugs to thin the blood.  Your doctor or nurse can give you more information.

Other side effects

Women sometimes find that chemotherapy treatment affects their periods.  They could become heavier, lighter or even stop altogether.  

It is important you do not become pregnant or father a child whilst having chemotherapy treatment as chemotherapy could damage the unborn baby.  

This chemotherapy can increase your skin’s sensitivity to the sun.  It is best to avoid strong sunlight, wear a hat and use a sun block.

Very rarely people on this chemotherapy may experience heart problems such as angina or palpitations.  If you wish to discuss this further please speak to your doctor.

Sometimes cancer drugs can have very serious side effects which rarely can be life threatening. It is important to inform Velindre cancer centre if you are concerned about any side-effects.

A diagnosis of cancer can increase your risk of developing a blood clot (thrombosis), and having cancer treatment may increase this risk further.  It is important to tell your doctor immediately if you have symptoms such as pain, redness and swelling in your leg, or breathlessness and chest pain.  

Blood clots can be very serious.  However, most clots can usually be successfully treated with drugs to thin the blood.  Your doctor or nurse can give you more information.

Manufacturer’s patient information leaflets

Velindre leaflets provide information about very common and commonly reported side-effects (we are unable to list all of the common side effects), for more information regarding these and the less common side-effects please refer to the manufacturers patient information leaflets, obtained from Velindre pharmacy and/or on the internet at Sometimes patients may find these leaflets difficult to read however. Please ask if you would like a copy from your doctor or from Velindre pharmacy

Contact telephone numbers

Velindre Cancer Centre 029 2061 5888

Ask for the treatment helpline if you are unwell at home and need immediate advice at any time of the day or night. For example you should phone if you:

  • Are sick more than once in 24 hours
  • Have a temperature of 37.5°C or above or below 35.5°centigrade
  • Have diarrhoea
  • If your hands or feet are very sore 

Pharmacy department 029 2061 5888 ext 6223

Monday – Friday 9am – 5pm for queries about your medicines

Tenovus freephone 0808 808 1010

cancer helpline 


This information is also available in Welsh

This leaflet was written by health professionals.  The information contained in this leaflet is evidence based.  It has been approved by doctors, nurses and patients.  It is reviewed and updated every 2 years.