Trastuzumab (315, A1109, A1110, A1111, A1112)

This leaflet provides information for patients having treatment with trastuzumab. The leaflet will explain what trastuzumab is and when and how it is given. It will also tell you about common side effects that you may experience. Contact telephone numbers and details of how to obtain further information on Trastuzumab are given at the end of the leaflet.

What is Trastuzumab and how does it work?

Your cancer showed a high level of a substance known as HER-2 (human epidermal growth factor 2). HER-2 is found on the outside of some cancer cells and it stimulates their growth.

Trastuzumab is an artificially made antibody which attaches itself to HER-2. It is known as a monoclonal antibody. Trastuzumab stops the cancer cells from dividing and growing by targeting the HER 2 receptors on the cells.

Trastuzumab appears to have little effect in people whose cancers have normal levels of HER-2.

Trastuzumab is made by different manufacturers. Herceptin and Ontruzant are both Trastuzumab but are made by different manufacturers. Many patients will be receiving Ontruzant as this is replacing the use of Herceptin in Wales. There is a separate leaflet to explain this.

How often will I receive Trastuzumab?

For this treatment to be most effective, it is given at specific time intervals. It usual to have Trastuzumab every 3 weeks. The exact number of treatments you will receive will be discussed by your doctor.

How often will I see the specialist team?

Your doctor will let you how often you will need to be seen

in the outpatient clinic. At each visit the nurse who gives your Trastuzumab will check how you are feeling and discuss any problems you may have.

How is Trastuzumab given?

Trastuzumab is given through a drip into a vein in the back of your hand or arm. However, sometimes, if your veins are difficult to find, it may be suggested that a fine tube called a PICC is inserted into a large vein in your upper arm. This will remain in place throughout the course of your treatment. Your doctor or nurse will discuss this further with you, if required. We have a leaflet that tells you more about PICC lines.

Where will my treatment be given?

The first two treatments will be given in a hospital. This may be in one of the day case treatment areas at Velindre or a hospital closer to your home. This is because we need to closely monitor you for side effects which usually only happen during the first two treatments.

After the first two treatments your Trastuzumab may be given in a local hospital, an outreach clinic or in your home by specially trained nurses. We will discuss this with you in clinic.

How long will my appointment take?

Your first Trastuzumab is given more slowly and we will observe you for approximately 2 hours after the infusion to check you are ok. Your first appointment may take approximately 4 hours.

Your second Trastuzumab treatment will be given slightly quicker. This appointment with take up to 2 hours, approximately.

All other Trastuzumab treatments will take approximately 1 hour.

Can I bring relatives and friends with me?

You are welcome to bring someone to stay with you during your treatment. Space is limited so there is not usually room for more than one person. Treatment areas are not suitable for young children.

What are the possible side effects?

Most people tolerate Trastuzumab treatment very well, with very few side effects. However, there are a number of possible side effects which can occur. The doctors, nurses and pharmacists can give you advice or answer any questions you may have.

Reactions during the treatment

Some patients may experience a reaction at the time the Trastuzumab is given. This is why the first treatment is given more slowly. A nurse will monitor you closely during the treatment.

If you experience any of the following during the treatment please tell your nurse straight away:

Feeling hot and feverish
Develop a temperature
Chills or shivering
Headache
Dizziness or faintness
Problems with breathing
Rash or itching
Feeling sick or vomiting
Swelling of face/mouth ( this is rare)
Pain in back, abdomen or chest

If any of these occur we will slow down or stop the Trastuzumab until you feel better. If needed, we will give you medication to help with the symptoms .The treatment can then start again, often without any further problems.

Sometimes patients can experience a temperature/shivering/feeling sick at home after the infusion on the first day. If this occurs, ring the treatment helpline. The telephone number is at the end of the leaflet.

Heart problems

Trastuzumab treatment may cause some heart problems. These will usually get better when Trastuzumab treatment is stopped or has completed. Your doctor will discuss this with you and arrange for your heart function to be tested before you start Trastuzumab. Your heart function may be monitored every 3 - 4 months for the first year of treatment. We will also check your blood pressure and monitor your weight regularly.

If you already have a heart condition or you take any heart medication, please tell your Velindre doctor before you start treatment with Trastuzumab. If you do develop heart problems whilst on Trastuzumab it may be treated with tablets. It is very important not to stop taking any tablets you have been given for heart problems without discussing it with your Velindre doctor or specialist nurse.

If at any time during your treatment you become short of breath- especially at rest, cough , tight chest, experience fluid retention (swelling) in your arms or legs, palpitations (heart flutter or irregular heart beat), feel dizzy or lightheaded, please contact the treatment helpline. The telephone number is at the end of the leaflet.

However, if you experience any chest pain, ring 999.

Side effects after treatment

Feeling sick:

If you feel sick after your treatment, anti-sickness medication can help. Ring the treatment helpline if you feel sick and need anti-sickness medication or the medication isn’t helping.

Feeling feverish :

If you feel shivery/cold/ feverish on the evening of your treatment, you can take paracetamol 4-6 hours apart, maximum of 8 in 24 hours. If you need 8 in 24 hours however, ring the treatment helpline.

Other common side effects you may experience in the first few days after treatment include:

Diarrhoea
Weakness
Tiredness
Headaches
Skin rashes
Abdominal pain
Joint pain
Muscle pain
Watery sore eyes
Difficulty sleeping.
Sore mouth
Altered taste

These side effects usually only last a few days. If you feel very unwell or want further advice please contact Velindre Cancer Centre. The telephone number is at the end of the leaflet.

Infection:

Some patient have Trastuzumab in combination with chemotherapy. You will be given a thermometer if having chemotherapy. Refer to the chemotherapy leaflet for advice.

However, if you experience any sign of infection, such as pain on passing urine, frequency, coughing any green phlegm, shivering/flu like symptoms, ring the treatment helpline. The telephone number is at the end of the leaflet.

Anaemia and low platelets:

If you feel tired, short of breath or notice excessive bruising or bleeding, ring the treatment helpline. This would normally be expected in patients having chemotherapy with Trastuzumab.

Lung problems :

Some patients may experience lung problems, if you feel short of breath at rest, cough, tight chest or any problems breathing , ring the treatment helpline. The telephone number is at the end of the leaflet.

There are other very common and common side effects with Herceptin/ Ontruzant, which are not often seen in practice. Please refer to the Electronics medicines compendium, SPC: Herceptin or Ontruzant, if you wish to read all the side effects possible.

Blood clots

A diagnosis of cancer can increase your risk of developing a blood clot (thrombosis), and having cancer treatment may increase this risk further. It is important to tell your doctor immediately if you have symptoms such as pain, redness and swelling in your leg, or breathlessness and chest pain.

Blood clots can be very serious. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information.

Other information

It is important you do not become pregnant whilst having Trastuzumab treatment, and for 7 months after completing the treatment. Breastfeeding is not recommended during treatment and for a minimum of 6 months following completion of treatment.

Taking other medication with Trastuzumab?

Trastuzumab can remain in your body for up to 6 months after you finish treatment. During this time you should tell your doctor or pharmacist that you have had Trastuzumab before starting any new medicines.

Do not take over the counter medication, herbal or alternative medicines.

Sometimes cancer drugs can have very serious side effects which rarely can be life threatening. It is important to inform Velindre cancer centre if you are concerned about any side-effects. The telephone number is at the end of the leaflet.

Blood clots can be very serious. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information

Manufacturer’s patient information leaflets

Velindre leaflets provide information about very common and commonly reported side-effects (we are unable to list all of the common side effects), for more information regarding these and the less common side-effects please refer to the manufacturers patient information leaflets, obtained from Velindre pharmacy and/or on the internet at www.medicines.org.uk. Sometimes patients may find these leaflets difficult to read however. Please ask if you would like a copy from your doctor or from Velindre pharmacy

Contact telephone numbers

Velindre Cancer Centre 029 2061 5888

If you are unwell at home and need immediate advice at any time of the day or night ask for the treatment helpline

Pharmacy department 029 2061 5888 ext 6223

Monday – Friday 9am – 5pm for queries about your medicines

Tenovus freephone 0808 808 1010

cancer helpline

Macmillan freephone Helpline 0808 808 0000

7 days a week 8am – 8pm for general queries on cancer

This leaflet was written by health professionals. The information contained in this leaflet is evidence based. The leaflet has been approved by doctors, nurses, pharmacists and patients. It is reviewed and updated every 2 years.

Reviewed March 2016 . Updated November 2018