• Monitor for signs and symptoms of infusion-related reactions (rash, vomiting, diarrhea, dermatitis, venous thromboembolic events, pulmonary embolism) during and after infusion. If Grade 1 reactions occur,↓ infusion rate by 50%. If Grade 2 reactions occur, hold infusion until resolved to Grade 0 or 1 and ↓ infusion rate by 50% rate for subsequent infusions. If Grade 3 or 4 reactions occur, permanently discontinue therapy.
• Assess for signs and symptoms of dermatologic toxicity (rash, dermatitis acneiform, acne, dry skin, pruritus, generalized rash, skin fissures, maculopapular rash, erythema) periodically during therapy; usually develops during first wk and resolves within 17 wk. If Grade 3 rash or acneiform rash develops, hold therapy until symptoms resolve to ≤Grade 2; then resume at ↓ dose of 400 mg for at least 1 treatment cycle. May ↑ dose to 600 mg or 800 mg in subsequent cycles if symptoms do not worsen. If Grade 3 rash or acneiform rash does not resolve to ≤Grade 2 within 6 wk, reactions worsen or become intolerable at 400 mg dose, Grade 3 skin induration/fibrosis occurs, or Grade 4 dermatologic toxicity occurs, permanently discontinue therapy.
• Monitor for venous (pulmonary embolism, deep vein thrombosis) and arterial (cerebral stroke and ischemia, MI) thromboembolic events.If symptoms of thromboembolism occur, discontinue therapy.

Lab Test Considerations:

• Monitor serum magnesium, potassium, and calcium prior to each dose of necitumumab, during, and for ≥8 wk following therapy. Electrolyte abnormalities usually occur between 4 and 9 wk of therapy. If Grade 3 or 4 electrolyte imbalances occur, hold therapy. May lead to sudden cardiopulmonary arrest. Administer subsequent cycles if electrolyte abnormalities are ≤Grade 2.