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Case Reports
. 2012 Jun 14:2012:bcr1220115374.
doi: 10.1136/bcr.12.2011.5374.

Cetuximab alleviates neuropathic pain despite tumour progression

Christian Kersten  1 , Marte Grønlie Cameron
Affiliations
Case Reports

Cetuximab alleviates neuropathic pain despite tumour progression

Christian Kersten et al. BMJ Case Rep. .

Abstract

The authors present the case of a 68-year-old male patient with metastatic rectal cancer. A pelvic recurrence resulted in neuropathic pain, radiating down his left leg. The pain was resistant to standard treatments. However, after nearly 3 years of debilitating pain, the patient experienced dramatic relief just hours after an infusion of the antiepidermal growth factor receptor antibody cetuximab. The analgesic effect lasted for 10-12 days and was repeated roughly every 12 days for three and a half years. To test for placebo effect, the patient received (unknown to him) 20% of his usual cetuximab dose and experienced no pain relief. The dramatic analgesic effect was documented in clinical notes, medication lists and in numeric rating scales even while his cancer was in radiological progression. Mitogen-activated protein kinase (MAPK)-signalling is believed to be an important driver of neuropathic pain and therefore, the authors hypothesise a direct inhibition of MAPK-signalling by cetuximab in neuronal or glial cells.

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Conflict of interest statement

Competing interests: We, the authors, have filed a US provisional patent application for the use of EGFR as a clinical target for treatment of neurological disorders. There are no other potential conflicts of interest.

Figures

Figure 1
Figure 1
(a–d) Cetuximab alleviates neuropathic pain despite tumour progression.
Figure 2
Figure 2
Recurrent and progressive rectal cancer. Arrows indicate tumour changes affecting the left sacral plexus and left sciatic nerve. (a) MRI taken three months prior to starting capecitabine, oxaliplatin and cetuximab (corresponds to MRI 2 in figure 1a). There is a presacral recurrence that extends along the left sciatic nerve. (b)MRI taken 4 months after starting capecitabine, oxaliplatin and cetuximab (corresponds to MRI 3 in figure 1b). Both the presacral recurrence and its extension along the sciatic nerve have increased in size. (c) MRI taken eight months after starting cetuximab monotherapy for analgesia (corresponds to MRI 4 in figure 1d). There is further progression of the recurrence in the presacral area and along the left sciatic nerve.
Figure 3
Figure 3
The patient reported pain immediately prior and subsequent to his last infusion of cetuximab (10-point rating scale).
See this image and copyright information in PMC

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