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Trastuzumab (Herceptin)

Trastuzumab is a targeted cancer drug and is also known by its brand name, Herceptin.

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

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.

Diagram showing a monoclonal antibody attached to a cancer cell

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 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
  • portacath

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. 

Tests during treatment

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.

Side effects

We haven't listed all the side effects. Your doctor or nurse will talk to you about the possible side effects. Tell your doctor or nurse if you notice anything unusual or different during and after treatment.

When to contact your team

Your doctor and nurse will monitor you closely for any side effects. Let your doctor or nurse know 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. 

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

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 headaches, aching muscles, cough, sore throat, pain passing urine, feeling cold and shivery or tooth ache. Infections can sometimes be life threatening. You should contact your team urgently if you think you have an infection. 

Breathlessness

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 petechia).

Allergic reaction

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.

Heart problems

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.

Fatigue

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.

Taste changes

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 doctor or nurse if you have this. They may 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.

Eye problems

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. 

Shaking

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 heavy 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 all put you off food and drinks.

Difficulty sleeping

It can help to change a few things about when and where you 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. 

Lung problems

You might develop a cough or breathing problems. This could be due to infection, such as pneumonia or inflammation of the lungs. 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.

Hair thinning

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
  • shingles
  • 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.

Important information

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.

Fertility

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 may be able to store sperm before starting treatment. Women may be able to store eggs or ovarian tissue but this is rare.

Breastfeeding

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.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for at least 6 months afterwards.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)
  • be in contact with other people who've had live vaccines as injections

Avoid close contact with people who’ve recently had live vaccines taken by mouth (oral vaccines) such as oral polio or the typhoid vaccine.

This also includes the rotavirus vaccine given to babies. The virus is in the baby’s poo for up to 2 weeks and could make you ill. So, avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.

You should also avoid close contact with children who have had the flu vaccine nasal spray if your immune system is severely weakened. 

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.

iWantGreatCare lets patients leave feedback on their experience of taking a particular drug. The feedback is from individual patients. It is not information, or specialist medical advice, from Cancer Research UK.

Last reviewed: 
03 Sep 2018
  • Electronic Medicines Compendium (eMC)

    Accessed March 2018

  • EPAR summary for the public - Herceptin (trastuzumab)
    European Medicines Agency, 2013

  • Breast Pathway Group – Subcutaneous Trastuzumab in Early Stage Breast Cancer

    London Cancer Alliance West and South, 2015

  • Breast Pathway Group – Intravenous Trastuzumab in Advanced Breast Cancer

    London Cancer Alliance West and South, 2016

  • Immunisation against infectious disease: Chapter 6: General contraindications to vaccination
    Public Health England
    First published: March 2013 and regularly updated on the Gov.UK website

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