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Side effects of pertuzumab (Perjeta)

Find out about the side effects of the targeted cancer drug pertuzumab.

Tell your doctor or nurse if you have any side effects so they can help you manage them. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Contact your doctor or nurse immediately if any of your side effects get severe or if you have signs of infection, including a temperature above 37.5C.

The side effects may be different if you are having pertuzumab with other cancer treatments. 

Common side effects

Each of these effects happens in more than 1 in 10 people (10%). You might have one or more of them.

Signs of an infection include headaches, aching muscles, a cough, a sore throat, pain passing urine, or feeling cold and shivery.

Contact your treatment centre straight away if you have any of these signs or if your temperature goes above 37.5C. Severe infections can be life threatening.

Cancer drugs can reduce the number of white blood cells in the blood. This increases your risk of infections. White blood cells help fight infections.

Your white blood cell level begins to fall after each treatment. Then it gradually goes up again.

When the level is very low it is called neutropenia (pronounced new-troh-pee-nee-ah).

You have antibiotics if you develop an infection. You might have them as tablets or as injections into the bloodstream (intravenously). To have them into your bloodstream you need to go into hospital.

This treatment makes the level of red blood cells fall (anaemia). You may feel breathless and look pale.

Red blood cells contain haemoglobin, which carries oxygen around the body. When the level of red blood cells is low you have less oxygen going to your cells.

You can also feel tired and depressed when your blood count is low and feel better once it is back to normal. The levels can rise and fall during your treatment. So it can feel like you are on an emotional and physical roller coaster.

You have regular blood tests to check your red blood cell levels. You might need a blood transfusion if the level is very low. After a transfusion, you will be less breathless and less pale.

Tell your doctor or nurse if you feel breathless.

You might notice you:

  • bruise more easily
  • have nosebleeds
  • have bleeding gums when you brush your teeth

This is due to a drop in the number of platelets that help clot your blood.

If your platelets get very low you may have lots of tiny red spots or bruises on your arms or legs called petechiae.

Tell your doctor or nurse straight away if you have petechiae.

You'll have a platelet transfusion if your platelet count is very low. It is a drip of a clear fluid containing platelets. It takes about 15 to 30 minutes. The new platelets start to work right away. 

Tell your doctor or nurse if you have diarrhoea. They can prescribe medicine to help you. 

Drink at least 2.5 litres of fluid a day. This helps to keep you hydrated.

Ask your nurse about soothing creams to apply around your back passage (rectum). The skin in that area can get very sore and even break if you have severe diarrhoea.

Contact your doctor or nurse immediately if you have diarrhoea 4 or more times a day, or any diarrhoea at night.

This occurs in about 6 out of 10 people (60%).

You might feel very tired during your treatment. It might take 6 months to a year for your energy levels to get back to normal after the treatment ends. A low red blood cell count will also make you feel tired.

You can do things to help yourself, including some gentle exercise. It’s important not to push yourself too hard. Try to eat a well balanced diet.

Talk to your doctor or nurse if you are finding the tiredness difficult to manage.

You might feel sick or be sick. Anti sickness injections and tablets can control it. Tell your doctor or nurse if you feel sick. You might need to try different anti sickness medicines to find one that works.

Tips 

  • Avoid eating or preparing food when you feel sick.
  • Avoid hot fried foods, fatty foods or foods with a strong smell.
  • Eat several small meals and snacks each day.
  • Relaxation techniques help control sickness for some people.
  • Ginger can help – try it as crystallised stem ginger, ginger tea or ginger ale.
  • Try fizzy drinks.
  • Sip high calorie drinks if you can’t eat.

You may have pain in your bones, muscles or tummy. You may also have headaches. Tell your doctor or nurse and they can tell you which painkillers to take. 

You might notice skin changes, such as dryness, itching and rashes similar to acne on your face, neck and trunk. 

Tell your doctor if you have any rashes or itching. Don't go swimming if you have a rash because the chlorine in the water can make it worse.

If your skin gets dry or itchy, smoothing in unperfumed moisturising cream may help. Check with your doctor or nurse before using any creams or lotions. Wear a high factor sun block if you’re going out in the sun.

This happens in 2 out of 10 people (20%).

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can all put you off food and drinks.

Tips

  • Eating several small meals and snacks throughout the day can be easier to manage.
  • Ask your doctor or nurse to recommend high calorie drinks to sip between treatments, if you are worried about losing weight.
  • You can make up calories between treatments for the days when you really don’t feel like eating.
  • Drink plenty of fluids even if you can't eat.
  • Don't fill your stomach with a large amount of liquid before eating.
  • Try to eat high calorie foods to keep your weight up.

Your mouth might become sore a few days after you start treatment. It usually clears up gradually 3 to 4 weeks after your treatment ends.        

Your nurse can give you mouthwashes to help prevent infection. You have to use these regularly to get the most protection.

Tell your doctor or nurse straight away if your mouth is really sore. They can help to reduce the discomfort. Some people need strong painkillers to help control mouth pain so they can eat and drink.

Tips

  • Clean your mouth and teeth gently, use a soft bristled toothbrush.
  • Avoid mouthwashes that contain alcohol.
  • Use dental floss daily but be gentle so that you don't harm your gums, and don't floss if you have very low platelets.
  • Avoid neat spirits, tobacco, hot spices, garlic, onion, vinegar and salty food.
  • Moisten meals with gravies and sauces to make swallowing easier.
  • Eating fresh or tinned pineapple can keep your mouth fresh and moist.
  • Avoid acidic fruits such as oranges, grapefruit or lemons.

This affects just over 2 out of every 10 people (20%).

Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking.

Tell your doctor or nurse if you are constipated for more than 3 days. They can prescribe a laxative.

This can happen in 2 out of 10 people (20%). 

Talk to your doctor or nurse if you’re having problems sleeping. It can help to change a few things about when and where you sleep.

Tips

  • Go to bed and get up at the same time each day.
  • Make sure the temperature is right.
  • Spend time relaxing before you go to bed - have a bath, read or listen to music.
  • Do some light exercise each day to help tire yourself out.
  • Avoid caffeine (coffee, tea, chocolate and cola drinks) after early afternoon.
  • Have a light snack before you go to bed to stop hunger waking you up.

Indigestion is pain or discomfort in your chest or stomach. It often happens shortly after eating or drinking.

Symptoms can also include:

  • heartburn, a burning sensation in the lower chest
  • feeling sick
  • feeling bloated
  • belching

This is caused by stomach acid irritating the foodpipe, the stomach or the top part of the bowel. Ask your doctor or nurse for anti heartburn medicines if you need them.

Tips

  • Stop smoking.
  • Limit your caffeine intake found in coffee and tea, canned drinks and chocolate.
  • Avoid foods and drinks that can cause heartburn, such as citrus fruits and alcohol.
  • Raise the head of your bed when sleeping or lying down.
  • Don't eat for 2 or 3 hours before going to bed.
  • Reduce fatty foods in your diet, such as deep fried foods.

Changes in taste can make you go off certain foods. Many people go off tea and coffee, for example. You might also find that some foods taste different. Some people find that they prefer to eat spicier foods.

Your taste usually gradually goes back to normal when your treatment is over. It may take a few weeks.

Tips

  • Choose foods that have strong flavours, such as herbs, spices, marinades and sauces if all your food tastes the same.
  • Season your food with spices or herbs, such as rosemary, basil and mint.
  • Garnish cold meat or cheese with pickle or chutney.
  • Try lemon or green tea if tea or coffee taste strange.
  • Sharp tasting fizzy drinks such as lemonade or ginger beer are refreshing.
  • Some people find that cold foods taste better than hot foods.

The swelling in your legs and feet is due to a build up of fluid. This is called peripheral oedema. Let your doctor or nurse know if you have any swelling.

Allergic reaction

Around 13 out of 100 people (13%) have this reaction. Tell your doctor or nurse immediately if you have any of these symptoms: 

  • feeling sick (nausea)
  • fever
  • chills
  • feeling tired
  • headache

A severe allergic reaction can happen in about 1 out of 10 people (10%). This may include:

  • swelling of your face and throat  
  • difficulty breathing

They will stop your drip if this happens and treat your symptoms.

Your nails can have a blue tinge or become darker. Or they might flake, be painful, or thicken where the nail starts growing (the nail bed). 

Tips

  • Use nail oils or moisturising creams if your nails are flaking.
  • Don't worry about marks on your nails as they will grow out in time.
  • You can cover marked nails with nail varnish but avoid quick drying varnishes as they can make your nails even drier.

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. It usually starts gradually within 2 to 3 weeks after treatment begins.

Your hair will grow back once your chemotherapy treatment has finished. This can take several months and your hair is likely to be softer. It can also grow back a different colour or be curlier than before.

Tips

  • Ask about getting a wig before you start treatment so you can match the colour and texture of your real hair.
  • You could choose a wig for a whole new look.
  • Think about having your hair cut short before your treatment starts.
  • Some people shave their hair off completely so they don't have to cope with their hair falling out.
  • Wear a hairnet at night so you won't wake up with hair all over your pillow.

You may have headaches, muscle aches (myalgia), a high temperature and shivering.

Numbness or tingling in fingers and toes can make it difficult to do fiddly things such as doing up buttons. This starts within a few days or weeks and can last for a few months. Rarely, the numbness may be permanent.

Tips

  • Keep your hands and feet warm.
  • Wear well fitting, protective shoes.
  • Take care when using hot water as you may not be able to feel how hot it is and could burn yourself.
  • Use oven gloves when cooking and protective gloves when gardening.
  • Moisturise your skin at least a couple of times a day.
  • Take care when cutting your nails.

Occasional side effects

Each of these effects happens in more than 1 in 100 people (1%). You might have one or more of them.

Watery eyes is also called excessive tearing or epiphora (pronounced ep-if-or-ah). It may be due to a blockage in the drainage system of the eye, caused by swelling of the nearby tissues. Or your eyes may make too many tears.

Tell your doctor or nurse if this is a problem. They can prescribe medicines to help reduce swelling.

Some irritants can make the watering worse. These can include dust, pollen or animal hairs. Try to avoid them or wear protective goggles.

Tell your doctor or nurse if you’re breathless or have a cough. This could be due to an infection, such as pneumonia. Or it could be caused by changes to the lung tissue, making it less flexible.

These include your blood pressure going up or down, or changes in your heart rhythm.

Your nurse or doctor will check your blood pressure and you will have ECGs if you need them.

Tell your doctor or nurse immediately if you have any chest pain.

This might happen to a few people and should get better once treatment stops. You will have heart tests before you start treatment and regularly throughout your treatment. You may not be able to have this drug if you already have particular heart conditions such as congestive heart failure or angina

Don’t drive or operate machinery if you have this.

About pertuzumab

More information about this treatment

We haven't listed all the very rare side effects of this treatment. For further information see the electronic Medicines Compendium (eMC) website.

You can report any side effect you have that isn’t listed here to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help