Adult Dosing
Adjuvant Treatment, Breast Cancer
- Combination therapy
- Initial dose: 4 mg/kg IV over 90 minutes, then 2 mg/kg IV over 30 minutes qwk
- Treat concurrently with paclitaxel/docetaxel for first 12 wks or 18 wks with docetaxel/carboplatin
- One week following the last weekly dose of therapy, administer 6 mg/kg IV over 30-90 minutes q3wks
- Monotherapy
- Initial dose: 8 mg/kg IV over 90 minutes
- Subsequent doses: 6 mg/kg IV over 30-90 minutes q3wks
- Begin treatment following completion of multi-modality, anthracycline-based chemotherapy regimens
Metastatic Treatment, Breast Cancer
- Initial dose: 4 mg/kg IV over 90 minutes
- Subsequent doses: 2 mg/kg IV qwk as 30 minutes until disease progression
- Give as monotherapy or in combination with paclitaxel
Metastatic Gastric Cancer
- Initial dose: 8 mg/kg IV over 90 minutes
- Subsequent doses: 6 mg/kg IV over 30-90 minutes q3wks until disease progression
Note:
- Administer as per one of the following doses and schedules for a total of 52 weeks of therapy
- Refer package insert for toxicity-related dose adjustments
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
- Left ventricular cardiac dysfunction, arrhythmias, hypertension, disabling cardiac failure, cardiomyopathy, cardiac death, and asymptomatic decline in left ventricular ejection fraction have been reported in patients receiving trastuzumab
- Withhold therapy if
16% absolute decrease in LVEF from pretreatment values or an LVEF value below institutional limits of normal and 10% absolute decrease in LVEF from pretreatment values - Conduct thorough cardiac assessment, including history, physical examination, and determination of LVEF by echocardiogram or MUGA scan during treatment
- Infusion reactions including fever and chills, nausea, vomiting, pain, headache, dizziness, dyspnea, hypotension, rash, and asthenia have been reported with trastuzumab. Discontinue the drug if patient experiences severe infusion reaction.
- Exposure to therapy during pregnancy may result in oligohydramnios and oligohydramnios sequence manifesting as pulmonary hypoplasia, skeletal abnormalities, and neonatal death [US Black Box Warning]
- Serious and fatal pulmonary toxicity which includes dyspnea, interstitial pneumonitis, pulmonary infiltrates, pleural effusions, non-cardiogenic pulmonary edema, pulmonary insufficiency, hypoxia, acute respiratory distress syndrome, and pulmonary fibrosis have been reported with trastuzumab; however, patients with symptomatic intrinsic lung disease, extensive tumor involvement of the lungs, resulting in dyspnea at rest, appear to have more severe toxicity
- Neutropenia and febrile neutropenia have been reported in patients receiving trastuzumab in combination with myelosuppressive chemotherapy as compared to those who received chemotherapy alone
- Detection of HER2 protein overexpression is necessary for selection of patients appropriate for trastuzumab therapy
Caution: Use cautiously in
- Hypersensitivity to hamster proteins
- Prior or concurrent cardiotoxic treatment
- Prior or concurrent antihypertensive treatment
- Symptomatic intrinsic lung disease
- Lung metastases
- Elderly patients
Pregnancy Category:D
Breastfeeding: It is unknown whether drug is excreted in human milk, but human IgG is excreted in human milk. Data suggest that breast milk antibodies do not enter the neonatal and infant circulation in substantial amounts. Manufacturer recommends discontinuation of breastfeeding, or discontinuation of the drug, taking into account the importance of the elimination half-life of trastuzumab and the importance of the drug to the mother.
Pricing data from www.DrugStore.com in U.S.A.
- Herceptin 440 MG SOLR [Vial] (GENENTECH)
1 mg = $3675.85
3 mg = $10814.2
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
