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Trastuzumab (Herceptin): Uses, Dosage, and Side Effects Overview
Summary of Key Points
Trastuzumab, commonly known by its brand name Herceptin, is a medication used to treat certain cancers, including HER2-positive breast and gastric cancers. It works by targeting the HER2 protein, which can contribute to cancer cell growth. Trastuzumab is often used in combination with other treatments, such as chemotherapy. It is important to follow your doctor’s instructions closely and report any side effects you may experience. For personalized care regarding Trastuzumab treatment, you can consult one of our telemedicine providers.
Names of Medication
US Brand Name: Herceptin
Trastuzumab is the generic name of the medication. The generic name refers to the active ingredient, while the brand name is assigned by the manufacturer.
Pharmacologic Category
HER2/neu receptor antagonist
Trastuzumab Dosing
Trastuzumab is used to treat several types of cancer, including HER2-positive breast and gastric cancers. The dosing schedule varies depending on the condition being treated. Always consult your doctor before making any changes to your dose or treatment plan. You can also schedule a telemedicine visit with one of our providers to discuss your Trastuzumab dosage and treatment options.
Breast Cancer (HER2-positive, Early-stage)
Initial dose: 8 mg/kg IV over 90 minutes
Maintenance dose: 6 mg/kg IV every 3 weeks for 1 year
Metastatic Breast Cancer (HER2-positive)
Initial dose: 4 mg/kg IV over 90 minutes
Maintenance dose: 2 mg/kg IV weekly until disease progression
Gastric Cancer (HER2-positive)
Initial dose: 8 mg/kg IV over 90 minutes
Maintenance dose: 6 mg/kg IV every 3 weeks until disease progression
Esophageal Cancer (HER2-positive)
Initial dose: 8 mg/kg IV over 90 minutes
Maintenance dose: 6 mg/kg IV every 3 weeks until disease progression
Locally Advanced Breast Cancer
Initial dose: 8 mg/kg IV over 90 minutes
Maintenance dose: 6 mg/kg IV every 3 weeks for 1 year
Recurrent Breast Cancer
Initial dose: 4 mg/kg IV over 90 minutes
Maintenance dose: 2 mg/kg IV weekly until disease progression
Non-Small Cell Lung Cancer (HER2-positive)
Initial dose: 8 mg/kg IV over 90 minutes
Maintenance dose: 6 mg/kg IV every 3 weeks until disease progression
Dosage Forms and Strengths
Trastuzumab is available in the following forms:
- Intravenous (IV) solution: 150 mg, 420 mg
- Subcutaneous injection: 600 mg/5 mL
Administration Instructions for Trastuzumab
Trastuzumab can be administered either as an intravenous (IV) infusion or a subcutaneous injection. The IV infusion is given slowly over 30 to 90 minutes, depending on the dose and how the patient responds. The subcutaneous injection is typically administered in the thigh over 2 to 5 minutes. Your healthcare provider will determine the most appropriate method for you. It is essential to attend all scheduled treatments and follow your doctor’s instructions carefully.
Adverse Reactions and Trastuzumab Side Effects
Like all medications, Trastuzumab can cause side effects. Some are more common, while others are rare but potentially serious. If you experience any side effects, contact your healthcare provider immediately. You can also schedule a telemedicine visit with one of our providers for advice on managing Trastuzumab side effects.
Common Side Effects
Fatigue: Feeling unusually tired or weak.
Nausea: A sensation of sickness in the stomach, which may lead to vomiting.
Fever: An elevated body temperature, often occurring after treatment.
Diarrhea: Loose or watery stools.
Serious Side Effects
Heart Problems: Trastuzumab can affect heart function, potentially leading to heart failure. Symptoms may include shortness of breath, swelling in the legs, and rapid weight gain.
Infusion Reactions: Some patients may experience allergic reactions during or after the infusion, such as chills, fever, or difficulty breathing.
Lung Problems: In rare cases, Trastuzumab can cause lung inflammation, which may result in coughing, difficulty breathing, and chest pain.
Contraindications for Trastuzumab
A contraindication is a specific condition where a treatment or medication should not be used due to potential harm. If you have any of the conditions listed below, you should not take Trastuzumab and should discuss alternative treatments with your healthcare provider.
Hypersensitivity to Trastuzumab: If you have had an allergic reaction to Trastuzumab or any of its components, you should not take this medication. Allergic reactions can range from mild skin rashes to severe, life-threatening reactions such as anaphylaxis.
Severe Heart Disease: Trastuzumab can cause heart problems, including heart failure. If you have a history of heart disease, such as congestive heart failure or cardiomyopathy, Trastuzumab may worsen your condition.
Pregnancy: Trastuzumab is not recommended during pregnancy due to the risk of harm to the developing fetus, including serious birth defects or fetal death.
Severe Lung Disease: Patients with pre-existing lung conditions, such as interstitial lung disease, may experience worsening lung function while on Trastuzumab.
Drug-to-Drug Interactions
Trastuzumab can interact with other medications, increasing the risk of side effects or reducing the effectiveness of treatment. Always inform your healthcare provider about any medications you are taking, including over-the-counter drugs and supplements. Some known drug interactions include:
Anthracyclines (e.g., Doxorubicin, Epirubicin): These chemotherapy drugs can increase the risk of heart damage when used with Trastuzumab.
Paclitaxel (brand name: Taxol): When used together, these drugs can increase the risk of heart problems and lung toxicity.
Cyclophosphamide (brand name: Cytoxan): This drug is often used in combination with Trastuzumab but may increase the risk of heart-related side effects.
Trastuzumab in Pregnancy
Is it safe to take Trastuzumab when pregnant?
Trastuzumab, commonly known as Herceptin, is not considered safe during pregnancy. It is classified as a pregnancy category D medication, meaning it poses significant risks to the developing fetus. These risks include serious birth defects, fetal harm, or even fetal death, particularly during the second and third trimesters. If you are pregnant or planning to become pregnant, it is crucial to discuss alternative treatment options with your healthcare provider. If you become pregnant while taking Trastuzumab, contact your healthcare provider immediately to determine the safest course of action.
Trastuzumab while Breastfeeding
Is it safe to take Trastuzumab while breastfeeding?
Breastfeeding is not recommended while undergoing treatment with Trastuzumab, as the medication may pass into breast milk and potentially harm a nursing infant. If you are currently breastfeeding or planning to breastfeed, consult your healthcare provider to explore alternative treatments or to discuss whether you should pause breastfeeding during Trastuzumab therapy.
Estimated Cost of Trastuzumab
The cost of Trastuzumab can vary depending on the dosage and the pharmacy you use. Without insurance, a 30-day supply with a GoodRx coupon is estimated to range between $1,000 and $3,000. Prices may fluctuate, but financial assistance programs are available to help offset the cost. Speak with your healthcare provider or pharmacist for more information on Trastuzumab pricing and insurance coverage options.
Possible Alternatives to Trastuzumab
If Trastuzumab is not suitable for you, other treatment options may be available depending on your specific type of cancer. Always consult your healthcare provider before making any changes to your treatment plan. You can also schedule a telemedicine appointment with one of our providers to discuss your options in more detail.
Breast Cancer
For breast cancer, alternatives to Trastuzumab include other targeted therapies like Pertuzumab (Perjeta) or hormone therapies such as Tamoxifen. In addition to medical treatments, lifestyle changes—such as maintaining a healthy diet, engaging in regular physical activity, and reducing alcohol consumption—can support your overall cancer management.
Gastric Cancer
For gastric cancer, alternative treatments may include chemotherapy drugs like Cisplatin or targeted therapies such as Ramucirumab (Cyramza). Dietary modifications, such as eating smaller, more frequent meals and avoiding irritants like spicy foods, may also help manage symptoms.
Esophageal Cancer
For esophageal cancer, treatment options may include radiation therapy or chemotherapy with drugs like Fluorouracil (5-FU). Additionally, quitting smoking and reducing alcohol intake can significantly improve treatment outcomes.
HER2-Positive Breast Cancer
For HER2-positive breast cancer, other targeted therapies such as Lapatinib (Tykerb) or Neratinib (Nerlynx) may be considered. Discuss with your healthcare provider whether these options are appropriate for your specific case.
HER2-Positive Gastric Cancer
For HER2-positive gastric cancer, alternatives like Ramucirumab (Cyramza) or chemotherapy combinations may be viable options. Your healthcare provider will work with you to determine the most effective treatment plan.
Metastatic Breast Cancer
For metastatic breast cancer, hormone therapies such as Letrozole (Femara) or chemotherapy drugs like Capecitabine (Xeloda) may be considered. Incorporating regular exercise and stress management techniques can also enhance your quality of life during treatment.
Early-Stage Breast Cancer
For early-stage breast cancer, hormonal therapies like Anastrozole (Arimidex) or radiation therapy may be suitable alternatives. Maintaining a healthy weight and staying physically active can further support your treatment and recovery.
Locally Advanced Breast Cancer
For locally advanced breast cancer, treatment options may include chemotherapy, radiation, or surgery. Your healthcare provider will help you determine the most appropriate approach based on your individual condition.
Recurrent Breast Cancer
For recurrent breast cancer, treatment options may involve additional surgery, radiation, or alternative targeted therapies. Your healthcare provider can guide you in selecting the best strategy for managing recurrence.
Non-Small Cell Lung Cancer
For non-small cell lung cancer, targeted therapies like Osimertinib (Tagrisso) or immunotherapies such as Pembrolizumab (Keytruda) may be considered. Quitting smoking and adopting a healthier lifestyle can also improve your treatment outcomes.
Recent Updates on Trastuzumab Research
Recent research is focused on improving the effectiveness of Trastuzumab by combining it with other therapies. Studies are exploring whether pairing Trastuzumab with immunotherapies or additional targeted treatments can enhance outcomes for patients with HER2-positive cancers. Additionally, efforts are underway to develop biosimilar versions of Trastuzumab, which could provide more affordable treatment options. Stay informed about these developments and discuss any new research or emerging treatments with your healthcare provider. You can also schedule a telemedicine appointment with one of our providers to review the latest treatment options tailored to your condition.
