Trastuzumab is a targeted cancer drug and is also known by its brand name, Herceptin, Herzuma and Ontruzant.
It is a treatment for cancers that have large amounts of a protein called human epidermal growth factor receptor 2 (HER2), such as:
- early breast cancer
- advanced breast cancer
- advanced stomach cancer
You might have the original drug called Herceptin, or a biosimilar such as Herzuma or Ontruzant. A biosimilar is a very similar copy of the original drug, but it is not exactly the same. Biosimilars undergo strict testing to check they work just as well as the original drug.
How it works
Some breast and stomach cancers have large amounts of human epidermal growth factor receptor 2 (HER2). They are called HER2 positive cancers. HER2 makes the cancer cells grow and divide.
Trastuzumab is a type of targeted cancer drug called a monoclonal antibody. It works by attaching to HER2 so it stops the cancer cells from growing and dividing.
How you have trastuzumab
For breast cancer, you might have trastuzumab as a drip into your bloodstream (intravenously) or as an injection under the skin (subcutaneous). If you have trastuzumab intravenously, you may be able to switch to the subcutaneous injection.
For stomach cancer, you usually have trastuzumab as a drip into your bloodstream.
Into your bloodstream
Each treatment takes between 30 and 90 minutes. You have the first treatment over 90 minutes and your team will check you for any side effects. Depending on the effects you have, the next infusion might be shorter.
You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:
- central line
- PICC line
If you don't have a central line, you might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.
As an injection under the skin
You might have trastuzumab as an injection under the skin, on the upper, outer part of your leg. The injection takes about 2 to 5 minutes.
It is important that your nurse changes which leg you have your injection in each time, to stop the area getting sore. They will check you for side effects for a few hours after the injection.
When you have trastuzumab
For early breast cancer
You might have trastuzumab alone, or together with chemotherapy. You have it before or after surgery and chemotherapy. You usually have it every week (weekly regimen) or every 3 weeks (3 weekly regimen). This continues for up to a year.
For advanced breast cancer
As the first treatment for breast cancer that has spread, you might have it together with the chemotherapy drugs paclitaxel (Taxol) or docetaxel (Taxotere) or with hormone therapies called aromatase inhibitors.
Trastuzumab is also used as a treatment on its own for people who have had at least 2 types of chemotherapy and where hormone therapy has not worked.
You might have it every week or every 3 weeks.
For advanced stomach cancer
You might have trastuzumab as the first treatment for a type of stomach cancer called adenocarcinoma of the stomach that has spread to other parts of the body. You usually have it together with the chemotherapy drug capecitabine (Xeloda) or with the drugs fluorouracil and cisplatin.
Trastuzumab is also used for cancer that started in the area where the food pipe meets the stomach (gastro oesophageal cancer).
You have it every 3 weeks.
You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
You will also have a heart trace test (ECG) and a heart scan before you start your treatment. You will have heart tests every few months while you are having trastuzumab and for some time after.
We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.
How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.
When to contact your team
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
- you have severe side effects
- your side effects aren’t getting any better
- your side effects are getting worse
Early treatment can help manage side effects better.
Common side effects
Each of these effects happens in more than 1 in 10 people (10%). You might have one or more of them. They include:
Risk of infection
Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.
Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.
You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.
Bruising and bleeding
This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).
This usually happens with the first or second treatment. Symptoms include a skin rash, itching, feeling hot and shivering. Other symptoms include redness of the face, dizziness, a headache, shortness of breath and anxiety.
Joint or muscle pain
You might feel some pain from your muscles and joints. Speak to your doctor or nurse about what painkillers you can take to help with this.
Diarrhoea or constipation
Tell your doctor or nurse if you have diarrhoea or constipation. They can give you medicine to help.
Hot flushes or sweats
We have some tips for coping with hot flushes and the possible treatments for men and women. Talk to your doctor if your hot flushes are hard to cope with. They might be able to prescribe you some medicines.
You may get heart problems, such as angina, heart failure or a heart attack. You will have regular heart checks during and after the treatment. Tell your doctor or nurse straight away if you have any chest pain.
Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.
Skin and nail problems
Skin and nail problems include a skin rash, dry skin, itching and darker skin. Your nails may also become brittle, dry, change colour or develop ridges. This usually goes back to normal when you finish treatment.
Mouth sores and ulcers
Mouth sores and ulcers can be painful. Keep your mouth and teeth clean; drink plenty of fluids; avoid acidic foods such as oranges, lemons and grapefruits; chew gum to keep the mouth moist and tell your doctor or nurse if you have ulcers.
Soreness, redness and peeling on hands and feet
The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.
Moisturise your skin regularly. Your doctor or nurse will tell you what moisturiser to use.
Taste changes may make you go off certain foods and drinks. You may also find that some foods taste different from usual or that you prefer to eat spicier foods. Your taste gradually goes back to normal a few weeks after your treatment finishes.
Tummy (abdominal) pain
Tell your treatment team if you have this. They can check the cause and give you medicine to help.
Blood pressure changes
During treatment, your blood pressure may be lower or higher than normal. Tell your nurse if you feel dizzy, faint, or if you have headaches, nosebleeds, blurred or double vision, or shortness of breath. Your blood pressure usually goes back to normal while you are on treatment or when treatment ends.
You might have eye problems including blurred vision, sore, red, itchy, dry eyes (conjunctivitis) or an infection. Tell your doctor or nurse if you have this. They can give you eye drops or other medication to help.
You might feel like you are shaking or have tremors.
Headaches and dizziness
Let your doctor or nurse know if you have headaches. They can give you painkillers. Don’t drive or operate machinery if you feel dizzy.
Swollen hands and feet
You may have swelling of your hands and legs due to a build up of fluid (oedema).
Loss of appetite
You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.
It can help to change a few things about how you try to sleep. Try to go to bed and get up at the same time each day and spend some time relaxing before you go to bed. Some light exercise each day may also help.
You might develop a cough or breathing problems. This could be due to infection, such as pneumonia or inflammation of the lungs (pneumonitis). Let your doctor or nurse know straight away if you suddenly become breathless or develop a cough.
A runny nose
You might have a runny nose while having treatment.
Feeling or being sick
Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.
It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.
Your hair may thin but you’re unlikely to lose all your hair. This usually starts after your first or second cycle of treatment. It is almost always temporary and your hair will grow back when you finish your treatment.
Flu like symptoms
This can happen a few hours after treatment. It may include headaches, muscle aches (myalgia), a high temperature and shivering. Taking paracetamol every 6 to 8 hours can help.
Occasional side effects
Each of these effects happens in more than 1 in 100 people (1%). You might have one or more of them. They include:
- anxiety or depression
- changes to the way your kidneys work
- infections such as chest or urine infection
- numbness or tingling in fingers and toes
- liver problems that are very mild and unlikely to cause symptoms
- dry mouth
Rare side effects
Each of these effects happens in fewer than 1 in 100 people (1%). You might have one or more of them.
- yellowing of the skin and whites of the eyes
- inflammation of the lungs
Coping with side effects
We have more information about side effects and tips on how to cope with them.
Other medicines, foods and drink
Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.
Pregnancy and contraception
This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for at least 7 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
You may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.
Don’t breastfeed during this treatment and for 7 months afterwards. The drug may come through in the breast milk.
Treatment for other conditions
Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.
Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).
- have other vaccines, but they might not give you as much protection as usual
- have the flu vaccine (as an injection)
Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.
If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.
Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.
More information about this treatment
For further information about this treatment go to the electronic Medicines Compendium (eMC) website.
You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.
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