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Trastuzumab Dosage

Applies to the following strength(s): 440 mg

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Adult Dose for:

Additional dosage 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.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

Infusion reactions:
-Decrease infusion rate for mild or moderate infusion reactions.
-Interrupt infusion for dyspnea or clinically significant hypotension.
-Discontinue for severe or life threatening infusion reactions.

Cardiomyopathy:
-Withhold dosing for at least 4 weeks for either 16% or greater absolute decrease in LVEF from baseline, or if LVEF below institutional limits of normal and 10% or greater decrease in LVEF from baseline.
-May resume treatment if within 4 to 8 weeks LVEF returns to normal limits and absolute decrease from baseline is 15% or less.
-Permanently discontinue if LVEF decline persists for greater than 8 weeks, or if dosing has been suspended on more than 3 occasions for cardiomyopathy.

Precautions

BOXED WARNINGS:
CARDIOMYOPATHY:
-Administration can result in sub-clinical and clinical cardiac failure.
-The incidence and severity was highest in patients receiving concomitant anthracycline containing regimens.
Recommendations:
-Evaluate left ventricular function in all patients prior to and during treatment.
-Discontinue treatment in patients receiving adjuvant therapy and withhold treatment in patients with metastatic disease for clinically significant decrease in left ventricular function.

INFUSION REACTIONS/PULMONARY TOXICITY:
-Administration can result in serious and fatal infusion reactions and pulmonary toxicity.
-Symptoms usually occur during or within 24 hours of administration.
Recommendations:
-Interrupt infusion for dyspnea or clinically significant hypotension.
-Monitor patients until symptoms completely resolve.
-Discontinue therapy for anaphylaxis, angioedema, interstitial pneumonitis, or acute respiratory distress syndrome.

EMBRYO-FETAL TOXICITY:
-Exposure during pregnancy can result in oligohydramnios and oligohydramnios sequence manifesting as pulmonary hypoplasia, skeletal abnormalities, and neonatal death.

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
-Do not give IV push or bolus.

Storage requirements: Refrigerate

Reconstitution/preparation techniques: The manufacturer product information should be consulted.

IV compatibility:
-Do not mix with other drugs.
-Do not use dextrose (5%) solution.

General:
To prevent medication errors, check the vial labels to ensure that the drug is trastuzumab and not ado-trastuzumab emtansine.

Patient advice:
-Advise patients to immediately report any new onset or worsening shortness of breath, cough, swelling of ankles or legs, swelling of face, palpitations, weight gain of more than 5 pounds in 24 hours, dizziness, or loss of consciousness.
-Advise women that exposure can result in fetal harm.
-Advise women of childbearing potential to use effective contraception during and for a minimum of 6 months after treatment.

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