trastuzumab

Generic Name: trastuzumab (tras TOO zoo mab)
Brand Name: Herceptin

What is trastuzumab?

Trastuzumab is a cancer medication that interferes with the growth and spread of cancer cells in the body.

Trastuzumab is used to treat certain types of breast cancer or stomach cancer. Other cancer medicines are sometimes used in combination with trastuzumab.

Trastuzumab may also be used for purposes not listed in this medication guide.

What is the most important information I should know about trastuzumab?

Do not use trastuzumab if you are pregnant. It could harm the unborn baby.

Trastuzumab can cause heart failure, especially if you have heart disease or if you are also receiving certain other cancer medicines.

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Some side effects may occur during the injection. Tell your caregiver right away if you feel dizzy, nauseated, light-headed, weak, short of breath, or if you have a headache, fever, chills, sudden chest pain, wheezing, dry cough, hives, or swelling of your face, lips, tongue, or throat.

What should I discuss with my health care provider before receiving trastuzumab?

You should not use trastuzumab if you are allergic to it.

To make sure trastuzumab is safe for you, tell your doctor if you have:

  • heart disease;

  • congestive heart failure;

  • a history of heart attack; or

  • any allergies or breathing problems.

Trastuzumab can cause heart failure, especially if you have heart disease or if you are also receiving certain other cancer medicines (such as daunorubicin, doxorubicin, epirubicin, or idarubicin)

FDA pregnancy category D. Do not use trastuzumab if you are pregnant. It could harm the unborn baby. Use effective birth control, and tell your doctor if you become pregnant during treatment.

If you are pregnant, your name may need to be listed on a Cancer and Childbirth registry when you start using this medication.

It is not known whether trastuzumab passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

How is trastuzumab given?

Trastuzumab is injected into a vein through an IV. You will receive this injection in a clinic or hospital setting. Trastuzumab must be given slowly, and the IV infusion can take up to 90 minutes to complete.

Before you receive this medication, you may need to undergo a biopsy to make sure trastuzumab is the right medication to treat your cancer.

Trastuzumab is usually given once every week or every 3 weeks. Follow your doctor's dosing instructions very carefully.

You may need frequent medical tests to be sure this medicine is not causing harmful effects. Your cancer treatments may be delayed based on the results of these tests.

What happens if I miss a dose?

Call your doctor for instructions if you miss an appointment for your trastuzumab injection.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while receiving trastuzumab?

Follow your doctor's instructions about any restrictions on food, beverages, or activity.

Trastuzumab side effects

Some side effects may occur during the injection. Tell your caregiver right away if you feel dizzy, nauseated, light-headed, weak, short of breath, or if you have a headache, fever, chills, sudden chest pain, wheezing, dry cough, hives, or swelling of your face, lips, tongue, or throat.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • shortness of breath (even with mild exertion or while lying down);

  • rapid or shallow breathing, grunting, gasping for breath, pain when you breathe;

  • blue-colored skin or lips;

  • sudden chest pain or discomfort, wheezing, new or worsening cough;

  • pounding heartbeats or fluttering in your chest;

  • swelling, rapid weight gain;

  • fever, swollen gums, painful mouth sores, pain when swallowing, skin sores, cold or flu symptoms; or

  • heart attack symptoms--chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating.

Common side effects may include:

  • nausea, diarrhea, weight loss;

  • fever, chills, mouth sores;

  • headache, sleep problems (insomnia);

  • cough, trouble breathing;

  • skin rash, bruising, pale skin;

  • altered sense of taste; or

  • cold symptoms such as stuffy nose, sinus pain, sneezing, cough, sore throat.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Trastuzumab dosing information

Usual Adult Dose for Breast Cancer:

Metastatic Breast Cancer:
Initial dose: 4 mg/kg IV over 90 minutes, alone or with paclitaxel
Maintenance dose: 2 mg/kg IV over 30 minutes once weekly

Duration of therapy: Until disease progression

Use:
-Metastatic breast cancer: in combination with paclitaxel for first line treatment of HER2 overexpressing metastatic breast cancer, OR as a single agent for treatment of HER2 overexpressing breast cancer in patients who have received one or more chemotherapy regimens for metastatic disease.

Usual Adult Dose for Breast Cancer -- Adjuvant:

Adjuvant Treatment of Breast Cancer:
-If given with, or following, paclitaxel, docetaxel, or docetaxel/carboplatin:
Initial dose: 4 mg/kg IV over 90 minutes, then 2 mg/kg IV over 30 minutes weekly for 12 weeks (paclitaxel or docetaxel) or 18 weeks (docetaxel/carboplatin)
Maintenance dose: 6 mg/kg IV over 30 to 90 minutes every 3 weeks, starting one week after completion of weekly dosing

-If used as a single agent within 3 weeks after multi-modality anthracycline-based regimens:
Initial dose: 8 mg/kg IV over 90 minutes
Maintenance dose: 6 mg/kg IV over 30 to 90 minutes every 3 weeks

Duration of therapy: 52 weeks

Comments: Extending adjuvant treatment beyond one year is not recommended.

Use:
-Adjuvant treatment of HER2 overexpressing node positive or node negative (ER/PR negative or with one high risk feature) breast cancer: as part of a treatment regimen consisting of doxorubicin, cyclophosphamide, and either paclitaxel or docetaxel, OR with docetaxel and carboplatin, OR as a single agent following multi-modality anthracycline based therapy.

Usual Adult Dose for Esophageal Carcinoma:

Metastatic Gastric Cancer:
Initial dose: 8 mg/kg IV over 90 minutes
Maintenance dose: 6 mg/kg IV over 30 to 90 minutes every 3 weeks

Duration of therapy: Until disease progression

Use:
-In combination with cisplatin and capecitabine or 5-fluorouracil, for the treatment of patients with HER2 overexpressing metastatic gastric or gastroesophageal junction adenocarcinoma, who have not received prior treatment for metastatic disease.

Usual Adult Dose for Gastric Cancer:

Metastatic Gastric Cancer:
Initial dose: 8 mg/kg IV over 90 minutes
Maintenance dose: 6 mg/kg IV over 30 to 90 minutes every 3 weeks

Duration of therapy: Until disease progression

Use:
-In combination with cisplatin and capecitabine or 5-fluorouracil, for the treatment of patients with HER2 overexpressing metastatic gastric or gastroesophageal junction adenocarcinoma, who have not received prior treatment for metastatic disease.

What other drugs will affect trastuzumab?

Other drugs may interact with trastuzumab, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about trastuzumab.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 8.01. Revision Date: 2014-08-03, 10:41:11 AM.

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