Angel

Brian answered your last question, explaining in plain english the prevailing theory most doctors use: combine the Erbitux with the chemo to maximize the effect. And as usual he's right that Erbitux alone is not commonly used first. I did not like what I read about the side effects and possible risks of cisplatin nor putting such a powerful poison into my bloodstream. Each medical team is different and mine was willing to substitute the killing effect of the more narrowly focused radiation for the cisplatin (which is why I had the max rads of 72 gy). I liked the whole MAB idea. So I took a chance on just Erbitux alone -knowing that the current "gold" standard is both. It was a decision I made, not the doctors, just like not getting a peg. Not the usual but worked for me.

As to side effects, the most common is the acne like rash and increased radiation dermatitis. In other words, your skin can blister up real bad and real red. My reaction was way worse than any of the patients my team had seen. On the other hand, some believe that the worst the skin reaction to Erbitux, the more effectively it is working. there were little things like every fast growing cell took a hit too, such as fingernails and toenails. Heck for the first time, even my ear hair slowed down. (inside old fogey joke)
Last but not least, it let me joke about Martha Stewart saving me.

targeted and biological therapies from the main site. http://www.oralcancerfoundation.org/treatment/targeted_therapies.htm

I am not sure if I would go as far as to call Erbitux the single most significant breakthrough in oral cancer therapy.
The MAB idea has been around for a long time, and while it is attractive to have a targeted drug it is not magic nor does it always work. Take Herceptin (another MAB used in breast cancer) it "only" works in 30-40 % of breast cancers. I am not sure what the percentage is in SCC but it would make sense to test if that particular cancer is responsive or not. This has at least in my case not been done.
As to side effects you have the common ones (you are inhibiting EGFR which normal cells also use). Erbitux is a large protein (about 1000x bigger than aspirin). Its composition has been partially been "humanized" to make it less immonogenic. But, because it is a foreign protein some people can have very serious reactions to it. In principle this is something that can be detected relatively easily, If the first time you are given the infusion this is done slowly and you are closely monitored. However that may not always happen even if you ask for it. (Hence the soap box and my warning)

Having said this, it is good to have another drug that one can use, particularly if the cancer is not platinum drug sensitive. I am not sure what the documented survival advantage is for Erbitux/IMRT vs cis/carboplatin/IMRT>>>> Brian??. Testing for markers could be beneficial here. Also, there is something attractive about the nonspecific nature of cisplatin especially if some cancer cells have started their migration...
I would have used Erbitux had this been possible, since it was not (I am one of the lucky 3%) it was cis- then carboplatin. In retrospect this was not a bad choice for the above reason. What appears to be important is to support IMRT with a drug regimen.

Markus

FYI:

www.erbitux.com
MPORTANT SAFETY INFORMATION
Severe allergic reactions due to Erbitux� (Cetuximab) therapy have occurred in 3% of 1373 patients receiving Erbitux during clinical studies.

Heart attack and/or sudden death occurred in 4 of 208 patients (2%) with head and neck cancer treated with radiation therapy and Erbitux as compared to none of 212 patients treated with radiation therapy alone

Markus
I should have given citations to my praise of Erbitux since that phrase was hardly original but widely quoted. There were just so many to choose from but let's use the gold standard, the OCF reader Oral Cancer News on Oct 15th:
"Merck Serono�s Erbitux� is one of the finalists for the prestigious International Prix Galien Award for excellence in pharmaceutical development and innovation due to its role in transforming the treatment of head and neck cancer.

Erbitux is the first and only targeted therapy approved for the treatment of squamous cell carcinoma of the head and neck (SCCHN) and works in a completely different way to conventional chemotherapies. Through its targeted mode of action, Erbitux blocks the epidermal growth factor receptor (EGFR), which is expressed in more than 90% of SCCHN tumors1 and is directly related to a poor prognosis for patients. The efficacy and tolerability of this novel drug have been shown in clinical trials2 - the latest of which, EXTREMEa, demonstrated the first significant advance in 30 years for the treatment of recurrent and/or metastatic SCCHN. "
My CCC is tracking me as part of their studies to get meaningful statistics for Erbitux /IMRT to go with their ongoing clinical study on platinum/IMRT vs Plat+Erb/IMRT. As noted above, the 90% figure for head & neck is a lot better than than the 40% for breast cancer MAB.

Angel
I should have mentioned a warning that if you have lived anywhere where there are a lot of "seed ticks" - such as Georgia or Tennessee - and you were bitten a lot hiking by seed ticks, then Erbitux is not for you as that is the number one cause of a bad reaction. Seems that the antibodies you develop from the tick bites mess up the MAB action. My CCC quizzed me about this and they won't use it on patients who came in from those southern states even though the conclusive studies are still being done, My experience was just with the old fashioned grown up ticks in the Northeast, so no problem.

You can google Erbitux and read the stated side effects [some of which are very scary] but the one my husband had the most problem with was the rash- all over his body with concurrant swelling in his fingers and toes. He had to stop the Erbitux on 2 occasions because of the rash and we never got the rash under control. In his case Erbitux was given as palliative tx after the chemo failed to stop the growth of the tumors. He was on it for 8 months +-. Amy