Herceptin (Trastuzumab) 440mg
Indications for HERCEPTIN:
HER2-overexpressing metastatic breast cancer as a single agent in patients who have received one or more chemotherapy regimens; or in combination with paclitaxel for first-line treatment. Adjuvant treatment in HER2-overexpressing, node-positive or node-negative breast cancer (as a single agent following multi-modality anthracycline based therapy; in combination with doxorubicin, cyclophosphamide, and either paclitaxel or docetaxel; or in combination with docetaxel and carboplatin).
Do not substitute for or with ado-trastuzumab emtansine. Give as IV infusion. Metastatic treatment (alone or with paclitaxel): initially 4mg/kg over 90mins, followed by 2mg/kg over 30mins once weekly until disease progression. Adjuvant treatment (give total of 52 weeks of trastuzumab) in combination therapy: initially 4mg/kg over 90mins, followed by 2mg/kg over 30mins once weekly for the 1st 12 weeks (concurrently w. paclitaxel or docetaxel) or 18 weeks (concurrently w. docetaxel/carboplatin). One week after the last trastuzumab weekly dose, give trastuzumab 6mg/kg over 30–90mins every 3 weeks. As single agent (within 3 weeks) following multi-modality anthracycline based therapy: initially 8mg/kg over 90mins, then 6mg/kg over 30–90mins every 3 weeks. Infusion reactions or cardiomyopathy: see full labeling.
Cardiomyopathy. Infusion reactions. Pulmonary toxicity. Embryo-fetal toxicity.
Increased risk of cardiomyopathy. Conduct cardiac assessment (eg, history, physical exam, LVEF) at baseline, every 3 months during and after therapy or every 6 months for ≥2yrs after therapy (if adjuvant); repeat LVEF at 4 week intervals if dose is withheld due to significant left ventricular cardiac dysfunction. Interrupt therapy if dyspnea or significant hypotension occurs; consider permanent discontinuation if severe infusion reactions, CHF, pulmonary toxicity, or significant left ventricular cardiac dysfunction develops. Symptomatic intrinsic lung disease. Extensive tumor involvement of the lungs. Test for HER2 protein overexpression and HER2 gene amplification using FDA-approved tests for specific tumor type (breast or gastric/gastroesophageal adenocarcinoma). Embryo-fetal toxicity (eg, oligohydramnios). Pregnancy: exclude status prior to initiation. Advise females of reproductive potential to use effective contraception during and for 7 months after last dose. Nursing mothers.
Human epidermal growth factor receptor (HER2) inhibitor.
Increased cardiomyopathy with anthracycline-containing chemotherapy; if possible, avoid for up to 7 months after discontinuing trastuzumab products. Increased toxicity with other myelosuppressives.
Headache, fever, arthralgia, nasopharyngitis, nausea, vomiting, diarrhea, chills, infections, increased cough, CHF, fatigue, dyspnea, rash, febrile neutropenia, anemia, myalgia; infusion reactions, exacerbation of chemotherapy-induced neutropenia, interstitial pneumonitis.
Enroll pregnant women with breast cancer who are using trastuzumab in the MotHER-the Herceptin Pregnancy Registry (800) 690-6720.
Testing considerations: HER2 protein overexpression or HER2 gene amplification
Vial—1 (w. diluent)